Compositions of bile acids and phenylbutyrate compounds

ABSTRACT

The present disclosure relates to compositions including a phenylbutyrate compound and a bile acid, and methods of processing such compositions.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of and claims priority under 35U.S.C. § 120 to U.S. patent application Ser. No. 17/557,626, filed onDec. 21, 2021, which is a continuation of U.S. patent application Ser.No. 16/940,102, filed on Jul. 27, 2020, which claims priority to U.S.Provisional Patent Application Ser. No. 62/948,756, filed Dec. 16, 2019and U.S. Patent Application Ser. No. 63/030,793, filed on May 27, 2020.The entire contents of each of these priority applications areincorporated herein by reference.

TECHNICAL FIELD

The present disclosure generally relates to pharmaceutical compositionsand methods of manufacturing the same.

BACKGROUND

The flow properties of powder and other bulk solids is an importantconsideration during the manufacturing of pharmaceutical compositions.In addition, particle size distribution also affects downstreamprocessing and packaging of the pharmaceutical products. Certain activepharmaceutical ingredients have poor flowability and a need exists forimproved pharmaceutical compositions with improved physical propertiesincluding improved flowability.

SUMMARY

The present disclosure relates to compositions comprising aphenylbutyrate compound and a bile acid and methods of processing thecompositions disclosed herein.

In one aspect, provided herein are compositions that include: (a) about15% to about 45% w/w of a phenylbutyrate compound; (b) about 5% to about15% w/w of a bile acid; (c) about 8% to about 24% w/w of dextrates; (d)about 1% to about 6% w/w of sugar alcohol; and (e) about 22% to about35% maltodextrin, where the phenylbutyrate compound and the bile acidhave a ratio by weight of about 3:1. In some embodiments, thecomposition includes about 8% to about 12% w/w of the bile acid. In someembodiments, the bile acid is selected from the group consisting of:taurursodiol (TURSO, also known as tauroursodeoxycholic acid (TUDCA)),ursodeoxycholic acid (UDCA), chenodeoxycholic acid, cholic acid,hyodeoxycholic acid, lithocholic acid, and glycoursodeoxycholic acid. Insome embodiments, the bile acid is TURSO. In some embodiments, thecomposition includes about 9.7% w/w of TURSO. In some embodiments, thecomposition include about 25% to about 35% w/w of the phenylbutyratecompound. In some embodiments, the phenylbutyrate compound is selectedfrom the group consisting of: 4-phenylbutyric acid (4-PBA), GlycerlyTri-(4-phenylbutyrate), phenylacetic acid, 2-(4-Methoxyphenoxy) aceticacid (2-POAA-OMe), 2-(4-Nitrophenoxy) acetic acid (2-POAA-NO2), and2-(2-Naphthyloxy) acetic acid (2-NOAA), and pharmaceutically acceptablesalts thereof. In some embodiments, the phenylbutyrate compound is apharmaceutically acceptable salt of 4-PBA. In some embodiments, thepharmaceutically acceptable salt of 4-PBA is sodium phenylbutyrate. Insome embodiments, the composition includes about 29.2% w/w of sodiumphenylbutyrate. In some embodiments, the composition includes about 10%to about 20% w/w of dextrates. In some embodiments, the compositionincludes about 15.6% w/w of dextrates. In some embodiments, thecomposition includes about 2% to about 5% w/w of sugar alcohol. In someembodiments, the sugar alcohol is selected from the group consisting of:sorbitol, xylitol, and mannitol. In some embodiments, the sugar alcoholis sorbitol. In some embodiments, the composition includes about 3.9%w/w of sorbitol. In some embodiments, the composition includes about 25%to about 32% w/w of maltodextrin. In some embodiments, the maltodextrinis pea maltodextrin. In some embodiments, the composition furtherincludes sucralose. In some embodiments, the composition includes about0.5% to about 5% w/w of sucralose. In some embodiments, the compositionincludes about 1% to about 3% w/w of sucralose. In some embodiments, thecomposition further includes one or more flavorants. In someembodiments, the composition includes about 2% to about 15% w/w of oneor more flavorants. In some embodiments, the composition includes about5% to about 10% w/w of flavorants.

In some embodiments, the composition further includes about 0.05% toabout 2% w/w of porous silica. In some embodiments, the compositionincludes about 0.05% to about 1.5% w/w of porous silica. In someembodiments, the porous silica has a higher H₂O adsorption capacity at arelative humidity of about 20% or higher as compared to that of fumedsilica. In some embodiments, the porous silica has a higher H₂Oadsorption capacity at a relative humidity of about 90% or higher ascompared to that of fumed silica. In some embodiments, the porous silicahas an H₂O adsorption capacity of about 5% to about 40% by weight at arelative humidity of about 50%. In some embodiments, the porous silicahas an H₂O adsorption capacity of about 30% to about 40% by weight at arelative humidity of about 50%. In some embodiments, the porous silicahas a higher porosity at a relative humidity of about 20% or higher ascompared to that of fumed silica. In some embodiments, the porous silicahas a higher porosity at relative humidity of about 90% or higher ascompared to that of fumed silica. In some embodiments, the porous silicahas an average pore volume of about 0.1 cc/gm to about 2.0 cc/gm. Insome embodiments, the porous silica has an average pore volume of about0.2 to about 0.8 cc/gm. In some embodiments, the porous silica has abulk density of about 100 g/L to about 600 g/L. In some embodiments, theporous silica has a bulk density of about 400 g/L to about 600 g/L.

In some embodiments, the composition further includes about 0.5% toabout 5% w/w of a buffering agent. In some embodiments, the bufferingagent is sodium phosphate. In some embodiments, the sodium phosphate issodium phosphate dibasic. In some embodiments, the composition includesabout 2.7% w/w of sodium phosphate dibasic. In some embodiments, thecomposition further includes about 0.05% to about 1% w/w of one or morelubricants. In some embodiments, the one or more lubricants are selectedfrom the group consisting of: sodium stearyl fumarate, magnesiumstearate, stearic acid, polyethylene glycol, glyceryl behenate, andhydrogenated oil. In some embodiments, the one or more lubricants issodium stearyl fumarate. In some embodiments, the composition includesabout 0.5% w/w of sodium stearyl fumarate.

In some embodiments, the composition has a Carr's index of about 25 orless. In some embodiments, the composition has a Carr's index of about20 or less. In some embodiments, the composition has a Carr's index ofabout 12 or less.

In some embodiments, provided herein are compositions that include:about 29.2% w/w of sodium phenylbutyrate; about 9.7% w/w of TURSO; about15.6% w/w of dextrates; about 3.9% w/w of sorbitol; about 1.9% w/w ofsucralose; about 28.3% w/w of maltodextrin; about 7.3% w/w offlavorants; about 0.1% w/w of silicon dioxide; about 2.7% w/w of sodiumphosphate; and about 0.5% w/w of sodium stearyl fumerate.

In another aspect, provided herein are methods of processing acomposition, the methods include: (i) roller compacting a pre-blendcomposition that includes sodium phenylbutyrate and TURSO, where thesodium phenylbutyrate and the TURSO have a ratio by weight of about 3:1,to thereby form a compacted pre-blend; and (ii) granulating thecompacted pre-blend to form granules having a Carr's index of about 12or less. In some embodiments, the pre-blend composition includes about15% to about 45% w/w of sodium phenylbutyrate and about 5% to about 15%w/w of TURSO. In some embodiments, the methods further include prior tostep (i), blending a first composition that includes sodiumphenylbutyrate and a second composition that includes TURSO, to form thepre-blend composition. In some embodiments, the first and secondcompositions are blended for an hour or less. In some embodiments, thefirst and second compositions are blended for 30 minutes or less. Insome embodiments, the first and second compositions are blended at aspeed of about 10 rpm to about 20 rpm. In some embodiments, the speed isabout 15 rpm. In some embodiments, step (i) includes roller compactingthe pre-blend composition by application of a compaction force of about5 kN/cm to about 15 kN/cm. In some embodiments, the compaction force isabout 8 kN/cm to about 12 kN/cm. In some embodiments, the compactionforce is about 10 kN/cm.

In some embodiments of any of the methods described herein, step (i)includes roller compacting the pre-blend composition between at leasttwo rotating rolls having a gap width of about 1 mm to about 5 mm. Insome embodiments, the gap width is about 2 mm to about 3 mm. In someembodiments, step (i) includes roller compacting the pre-blendcomposition between at least two rotating rolls having a roll speed ofabout 4 rpm to about 12 rpm. step (i) includes roller compacting thepre-blend composition at a temperature of about 10° C. to about 30° C.In some embodiments, the methods include cooling the pre-blendcomposition to a temperature of about 12° C. to about 18° C.

In some embodiments of any of the methods described herein, step (ii)comprises granulating the compacted pre-blend using a granulation screenwith a diameter of about 0.8 mm to about 2 mm. In some embodiments, thediameter is about 1.5 mm. In some embodiments, the methods include,prior to blending the first and second composition, sieving the firstand second composition. In some embodiments, the granules have a bulkdensity of about 0.2 g/mL to about 1.0 g/mL. In some embodiments, thebulk density is about 0.5 g/mL to about 0.7 g/mL. In some embodiments,the granules have a tapped density of about 0.5 g/mL to about 1.2 g/mL.In some embodiments, the tapped density is about 0.7 g/mL to about 0.9g/mL. In some embodiments, the granules have a Carr's index of about 10or less. In some embodiments, the dissolution time for releasing about75% of the TURSO in the granules is between about 0.5 to about 15minutes. In some embodiments, the dissolution time for releasing about75% of the TURSO in the granules is between about 0.5 to about 5minutes. In some embodiments, the dissolution time for releasing about75% of the sodium phenylbutyrate in the granules is between about 0.5 toabout 15 minutes. In some embodiments, the dissolution time forreleasing about 75% of the sodium phenylbutyrate in the granules isbetween about 0.5 to about 5 minutes.

In some embodiments of any of the methods described herein, thecomposition further includes: about 8% to about 24% w/w of dextrates;about 1% to about 6% w/w of sugar alcohol; and about 22% to about 35%w/w of maltodextrin. In some embodiments, the composition includes:about 29.2% w/w of sodium phenylbutyrate; about 9.7% w/w of TURSO; about15.6% w/w of dextrates; about 3.9% w/w of sorbitol; about 1.9% w/w ofsucralose; about 28.3% w/w of maltodextrin; about 7.3% w/w offlavorants; about 0.1% w/w of silicon dioxide; about 2.7% w/w of sodiumphosphate; and about 0.5% w/w of sodium stearyl fumerate.

Unless otherwise defined, all terms of art, notations, and otherscientific terms or terminology used herein are intended to have themeanings commonly understood by those of skill in the art to which thisapplication pertains. In some cases, terms with commonly understoodmeanings are defined herein for clarity and/or for ready reference, andthe inclusion of such definitions herein should not necessarily beconstrued to represent a substantial difference over what is generallyunderstood in the art.

Where a range of values is provided, it is understood that eachintervening value, to the tenth of the unit of the lower limit unlessthe context clearly dictates otherwise, between the upper and lowerlimit of that range and any other stated or intervening value in thatstated range, is encompassed within the disclosure. The upper and lowerlimits of these smaller ranges may independently be included in thesmaller ranges, and are also encompassed within the disclosure, subjectto any specifically excluded limit in the stated range. Where the statedrange includes one or both of the limits, ranges excluding either orboth of those included limits are also included in the disclosure.

Certain ranges are presented herein with numerical values being precededby the term “about.” The term “about” is used herein to provide literalsupport for the exact number that it precedes, as well as a number thatis near to or approximately the number that the term precedes. Indetermining whether a number is near to or approximately a specificallyrecited number, the near or approximating unrecited number may be anumber which, in the context in which it is presented, provides thesubstantial equivalent of the specifically recited number.

It is appreciated that certain features of the disclosure, which are,for clarity, described in the context of separate embodiments, may alsobe provided in combination in a single embodiment. Conversely, variousfeatures of the disclosure, which are, for brevity, described in thecontext of a single embodiment, may also be provided separately or inany suitable sub-combination. All combinations of the embodimentspertaining to the disclosure are specifically embraced by the presentdisclosure and are disclosed herein just as if each and everycombination was individually and explicitly disclosed. In addition, allsub-combinations of the various embodiments and elements thereof arealso specifically embraced by the present disclosure and are disclosedherein just as if each and every such sub-combination was individuallyand explicitly disclosed herein.

Although methods and materials similar or equivalent to those describedherein can be used in the practice or testing of the present invention,suitable methods and materials are described below. All publications,patent applications, patents, and other references mentioned herein areincorporated by reference in their entirety. In case of conflict, thepresent specification, including definitions, will control. In addition,the materials, methods, and examples are illustrative only and notintended to be limiting.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows the particle size distribution of sodium phenylbutyrate andTURSO.

FIG. 2 is a DVS isotherm plot of sodium phenylbutyrate sorption anddesorption.

FIG. 3 is a DVS isotherm plot of TURSO sorption and desorption.

FIG. 4 is a DVS isotherm plot showing sorption and desorption of theactive blend.

FIG. 5 shows particle size distribution of blends that contain differentsilica types.

FIG. 6 shows the locations in the 16 Quart V-Shell where blenduniformity samples were obtained.

FIG. 7 shows the particle size distribution of the various samples afterpre-blending.

FIG. 8 shows the particle size distribution of the various samples aftergranulation with a screen size of 1.0 mm.

FIG. 9 shows the particle size distribution of the various samples aftergranulation with a screen size of 1.5 mm.

FIG. 10 shows the particle size distribution of the various samplesafter granulation with a screen size of 2.0 mm.

FIG. 11 shows the combined results from FIGS. 8-10 .

FIG. 12 is a graph showing the dissolution profiles of TUDCA in thevarious sub-batches.

FIG. 13 is a graph showing the dissolution profiles of sodiumphenylbutyrate in the various sub-batches.

FIG. 14 shows the locations where blend uniformity samples were obtainedfor the final blending analysis.

FIG. 15 shows the particle size distribution of the pre-blend for aplacebo batch.

FIG. 16 shows the particle size distribution of the compacted granulesfor a placebo batch.

DETAILED DESCRIPTION

Active pharmaceutical ingredients, such as bile acids and phenylbutyratecompounds can have poor flow properties, which affect, among otherthings, downstream processing, including mixing, scale-up, and packagingof powdered pharmaceutical products. Agglomeration of the powderedmaterials can also affect content uniformity and downstream processing.The present disclosure provides formulations containing bile acids andphenylbutyrate compounds and methods of manufacturing the same thatdemonstrate improved flow properties, uniformity, stability, and reducedagglomeration of the final granulate product. Accordingly, the presentdisclosure provides compositions that include (a) about 15% to about 45%w/w of a phenylbutyrate compound (e.g., any of the phenylbutyratecompounds described herein or known in the art); (b) about 5% to about15% w/w of a bile acid (e.g., any of the bile acids described herein orknown in the art); (c) about 8% to about 24% w/w of dextrates (e.g., anyof the dextrates described herein or known in the art); (d) about 1% toabout 6% w/w of sugar alcohol (e.g., any of the sugar alcohols describedherein or known in the art); and (e) about 22% to about 35%maltodextrin, wherein the phenylbutyrate compound and the bile acid havea ratio by weight of about 3:1. The compositions of the presentdisclosure can have a Carr's index of about 25 or less, about 20 orless, or about 12 or less. In some embodiments of any of thecompositions described herein, the composition is water soluble.

The manufacturing methods provided herein are based in part on a drygranulation process. The present inventors have discovered method ofprocessing a composition that result in improved flow properties andstability as compared to the active pharmaceutical compositions alone.Accordingly, provided herein are methods of processing a composition,the methods include: (i) roller compacting a pre-blend compositioncomprising sodium phenylbutyrate and TURSO, wherein the sodiumphenylbutyrate and the TURSO have a ratio by weight of about 3:1, tothereby form a compacted pre-blend; and (ii) granulating the compactedpre-blend to form granules having a Carr's index of about 12 or less.The methods described herein can also include prior to step (i) blendinga first composition comprising sodium phenylbutyrate and a secondcomposition comprising TURSO, to form the pre-blend composition.

Carr's Index

In some embodiments of any of the compositions described herein, thecomposition has a Carr's index of about 25 or less. For example, thecomposition can have a Carr's index of about 21 to about 25 (e.g., about22, 23, or 24), about 16 to about 20 (e.g., about 17, 18, or 19), about11 to about 15 (e.g. about 12, 13, or 14), or about 10 or less (e.g., 9,8, 7, 6, 5, 4, 3, 2, or 1). In some embodiments, the composition has aCarr's index of about 26 to about 31 (e.g., about 27, 28, 29, or 30),about 32 to about 37 (e.g., about 32, 33, 34, 35, or 36), or above about38.

The Carr's index (or Carr's compressibility index) of a composition canindicate the compressibility (or the propensity of a composition to becompressed) and flowability of a material. In some cases, Carr's indexis associated with the bulk and tapped density of a material. Bulkdensity is a property of materials such as powders and granules, and canbe measured by dividing the mass of the particles in the material by thetotal volume occupied. The total volume can include particle volume,inter-particle void volume, and/or internal pore volume. For a powdermaterial, bulk density can depend on both the density of the particlesand the spatial arrangement of the particles in the powder. Tappeddensity is typically an increased bulk density attained after aspecified compaction process, such as mechanically tapping or vibratinga container containing the material.

Bulk density and tapped density of a composition containing powders orgranules can be measured using methods known in the art. For example,the bulk density of a powder can be the ratio between the mass andvolume of an untapped sample. The bulk density of a powder can also bedetermined by measuring the volume of a known weight of a powder samplethat may have been passed through a sieve, into a container (e.g., agraduated cylinder), or by measuring the mass of a known volume ofpowder that has been passed through a volumeter into a container. Tappeddensity can be obtained, for example, by mechanically tapping acontainer (e.g., a graduated measuring cylinder or vessel) containingthe sample. The Carr's index of a material can be calculated based onthe bulk and tapped densities, for example, according to the formulaC=100 (1−pB/pT) (C stands for Carr's index, pB stands for bulk density,and pT stands for tapped density). Additional methods of determining theCarr's index of a material can be found at, e.g., ASTM-D6393, Standardtest method for bulk solids characterization by Carr indices, J. ASTMInt. 04.09 (2014); and R. E. Riley, H. H. Hausner, Effect of particlesize distribution on the friction in a powder mass, Int. J. PowderMetall. 6 (1970) 17-22.

Carr's index can indicate the flowability of a material. For example, ahigher Carr's index (a larger difference in bulk versus tappeddensities) can be associated with lower flowability. Hausner ratio, orthe tapped-to-bulk density ratio, which can be expressed as H=pT/pB, canalso be associated with the flowability of a material.

Additional flow indices are also contemplated herein for measuring theflowability of a material, such as the angle of repose. The angle ofrepose of a granular material can be represented by the steepest slopeof the unconfined material, measured from the horizontal plane on whichthe material can be heaped without collapsing (See, e.g., Mehta et al.Prog. Phys. 57 (1994) 383-416). Exemplary methods of measuring the angleof repose of a material can be found at, e.g. Beakawi et al., PowderTechnology 330 (2018) 397-417. For powders, which can be defined assmall-sized granular materials subject to cohesion and suspension in agas, the definition of the angle of repose can be associated with theHausner ratio (See, e.g. Beddow Part. Part. Syst. Charact. 12 (4): 213,1995), and the powders can flow at angles greater than the angle ofrepose. The angle of repose can also indicate the cohesiveness of thegranular material, referring to the Carr classification of flowabilityshown below.

Description Repose Angle Very free-flowing <30° Free flowing 30-38° Fairto passable flow 38-45° Cohesive 45-55° Very cohesive (non-flowing) >55°

Bile Acids

The present disclosure provides compositions that include about 5% toabout 15% w/w (e.g., about 6% to about 14%, about 7% to about 13%, about8% to about 12%, about 8% to about 11%, about 9% to about 10%, or about9.7% w/w) of a bile acid. Bile acids as described herein can includenaturally occurring surfactants having a nucleus derived from cholanicacid substituted with a 3α-hydroxyl group, and optionally with otherhydroxyl groups, typically at the C6, C7 or C12 position of the sterolnucleus. Suitable bile acids include but are not limited to,Taurursodiol (TURSO), ursodeoxycholic acid (UDCA), chenodeoxycholic acid(also referred to as “chenodiol” or “chenic acid”), cholic acid,hyodeoxycholic acid, deoxycholic acid, 7-oxolithocholic acid,lithocholic acid, iododeoxycholic acid, iocholic acid,taurochenodeoxycholic acid, taurodeoxycholic acid, glycoursodeoxycholicacid, taurocholic acid, glycocholic acid, cholic acid, or an analog,derivative, or prodrug thereof. In some embodiments, the bile acids arehydrophilic bile acids, including but not limited to, TURSO, UDCA,chenodeoxycholic acid, cholic acid, hyodeoxycholic acid, lithocholicacid, and glycoursodeoxycholic acid. Pharmaceutically acceptable saltsor solvates of any of the bile acids described herein are alsocontemplated. Bile acid derivatives are also contemplated, which includebut are not limited to derivatives formed at the hydroxyl and carboxylicacid groups of the bile acid with other functional groups such ashalogens and amino groups. TURSO and Taursodeoxycholic acid (TUDCA) areused interchangeably herein.

The bile acid described herein can be TURSO as shown in formula I (withlabeled carbons to assist in understanding where substitutions may bemade).

The compositions described herein can include about 5% to about 15% w/w(e.g., any of the subranges of this range described herein) of TURSO. Insome embodiments, the composition includes about 9.7% of TURSO. TheTURSO of any of the compositions described herein can have a Carr'sindex of about 22 to about 26 (e.g., about 23, 24, or 25).

The bile acid described herein can be UDCA as shown in formula II (withlabeled carbons to assist in understanding where substitutions may bemade).

Physiologically related bile acid derivatives, for example, compoundshaving any combination of substitutions of hydrogen at position 3 or 7and/or a shift in the stereochemistry of the hydroxyl group at positions3 or 7 in the formula of TURSO or UDCA are suitable for use in thepresent composition.

Amino acid conjugates of any of the bile acids described herein or knownin the art, or a pharmaceutically acceptable salt thereof are alsosuitable for the presently described compositions. The amino acid in theconjugate can be, but are not limited to, taurine, glycine, glutamine,asparagine, methionine, or carbocysteine. For example, encompassed bythe present disclosure is a compound of formula III:

wherein R is —H or C₁-C₄ alkyl; R₁ is —CH₂—SO₃R₃ and R₂ is —H; or R₁ is—COOH and R₂ is —CH₂—CH₂—CONH₂, —CH₂—CONH₂, —CH₂—CH₂—SCH₃, or—CH₂—S—CH₂—COOH; and R₃ is —H or the residue of a basic amino acid, or apharmaceutically acceptable salt, analog, derivative, prodrug thereof,or a mixture thereof.

Phenylbutyrate Compounds

The present disclosure provides compositions that include about 15% toabout 45% w/w (e.g., about 20% to about 40%, about 25% to about 35%,about 28% to about 32%, or about 29% to about 30%, e.g., about 29.2%w/w) of a phenylbutyrate compound. Phenylbutyrate compounds describedherein encompass phenylbutyrate (a low molecular weight aromaticcarboxylic acid) as a free acid (4-phenylbutyrate (4-PBA),4-phenylbutyric acid, or phenylbutyric acid), and pharmaceuticallyacceptable salts, co-crystal, polymorph, hydrate, solvates, conjugates,derivatives or prodrugs thereof. Phenylbutyrate compounds describedherein also encompass analogs of 4-PBA, including but not limited to,Glycerly Tri-(4-phenylbutyrate), phenylacetic acid (which is the activemetabolite of 4-PBA), 2-(4-Methoxyphenoxy) acetic acid (2-POAA-OMe),2-(4-Nitrophenoxy) acetic acid (2-POAA-NO2), and 2-(2-Naphthyloxy)acetic acid (2-NOAA), and their pharmaceutically acceptable salts. Thestructures of the 4-PBA analogs can be found at e.g., Zhang et al., Br JPharmacol 2013 October; 170(4): 822-834. Phenylbutyrate compounds alsoencompass physiologically related 4-PBA species, such as but not limitedto those having any substitutions for Hydrogens with Deuterium in thestructure of 4-PBA. Physiologically acceptable salts of 4-PBA, include,for example sodium, potassium, magnesium and calcium salts.

In some embodiments, the present disclosure provides compositionscomprising about 15% to about 45% w/w (e.g., any of the subranges ofthis range described herein) of sodium phenylbutyrate. In someembodiments, the composition includes about 29.2% of sodiumphenylbutyrate. The sodium phenylbutyrate of any of the compositionsdescribed herein can have a Carr's index of about 35 or more (e.g.,about 36, 37, 38, 39, or 40 or more). Sodium phenylbutyrate has thefollowing structure:

In some instances, the combination of a bile acid (e.g., TURSO) and aphenylbutyrate compound (e.g. sodium phenylbutyrate) has synergisticefficacy when administered to a subject for treating one or moresymptoms associated with neurodegenerative diseases. Exemplaryneurodegenerative diseases include, but are not limited to, amyotrophiclateral sclerosis (ALS), Alzheimer's disease, Multiple Sclerosis (MS),Parkinson's disease, Huntington's disease, stroke, Pick's Disease,Multi-Infarct Dementia, Creutzfeldt-Jakob's Disease, Dementia with Lewybodies, Mixed dementia and Frontotemporal dementia. The combination of abile acid and a phenylbutyrate compound can, for example, induce amathematically synergistic increase in neuronal viability in a strongoxidative insult model (H₂O₂-mediated toxicity) by linear modeling. Suchcombination therapies are disclosed in U.S. Pat. Nos. 9,872,865 and10,251,896.

In some embodiments, the phenylbutyrate compound and the bile acid inthe compositions provided herein have a ratio by weight of between about1:1 to about 4:1 (e.g., 2:1 or 3:1). In some embodiments, thephenylbutyrate compound and the bile acid in the compositions providedherein have a ratio by weight of between about 3:1.

Dextrates

Some embodiments of any of the compositions described herein includeabout 8% to about 24% w/w (e.g., about 9% to about 23%, about 10% toabout 22%, about 10% to about 20%, about 11% to about 21%, about 12% toabout 20%, about 13% to about 19%, about 14% to about 18%, about 14% toabout 17%, about 15% to about 16%, or about 15.6% w/w) of dextrates.Both anhydrous and hydrated dextrates are contemplated herein. Thedextrates of the present disclosure can include a mixture of saccharidesdeveloped from controlled enzymatic hydrolysis of starch. Someembodiments of any of the compositions described herein include hydrateddextrates (e.g., NF grade, obtained from JRS Pharma, ColonialScientific, or Quadra).

Sugar Alcohol

Some embodiments of any of the compositions described herein includeabout 1% to about 6% w/w (e.g., about 2% to about 5%, about 3% to about4%, or about 3.9% w/w) of sugar alcohol. Sugar alcohols can be derivedfrom sugars and contain one hydroxyl group (—OH) attached to each carbonatom. Both disaccharides and monosaccharides can form sugar alcohols.Sugar alcohols can be natural or produced by hydrogenation of sugars.Exemplary sugar alcohols include but are not limited to, sorbitol,xylitol, and mannitol. In some embodiments, the composition comprisesabout 1% to about 6% w/w (e.g., about 2% to about 5%, about 3% to about4%, or about 3.9% w/w) of sorbitol.

Maltodextrin

Some embodiments of any of the compositions described herein includeabout 22% to about 35% w/w (e.g., about 22% to about 33%, about 24% toabout 31%, about 25% to about 32%, about 26% to about 30%, or about 28%to about 29% w/w, e.g., about 28.3% w/w) of maltodextrin. Maltodextrincan form a flexible helix enabling the entrapment of the activeingredients (e.g., any of the phenylbutyrate compounds and bile acidsdescribed herein) when solubilized into solution, thereby masking thetaste of the active ingredients. Maltodextrin produced from any suitablesources are contemplated herein, including but not limited to, pea,rice, tapioca, corn, and potato. In some embodiments, the maltodextrinis pea maltodextrin. In some embodiments, the composition includes about28.3% w/w of pea maltodextrin. For example, pea maltodextrin obtainedfrom Roquette (KLEPTOSE® LINECAPS) can be used.

Sucralose

Some embodiments of any of the compositions described herein furtherinclude sucralose. In some embodiments, the compositions describedherein include about 0.5% to about 5% w/w (e.g., about 1% to about 4%,about 1% to about 3%, or about 1% to about 2%, e.g., about 1.9% w/w) ofsucralose. Other sugar substitutes contemplated herein include but arenot limited to aspartame, neotame, acesulfame potassium, saccharin, andadvantame.

Flavorants

Some embodiments of any of the compositions described herein furtherinclude one or more flavorants. In some embodiments, the compositionsdescribed herein include about 2% to about 15% w/w (e.g., about 3% toabout 13%, about 3% to about 12%, about 4% to about 9%, about 5% toabout 10%, or about 5% to about 8%, e.g., about 7.3% w/w) of flavorants.Flavorants can include substances that give another substance flavor, oralter the characteristics of a composition by affecting its taste.Flavorants can be used to mask unpleasant tastes without affectingphysical and chemical stability, and can be selected based on the tasteof the drug to be incorporated. Suitable flavorants include but are notlimited to natural flavoring substances, artificial flavoringsubstances, and imitation flavors. In some embodiments, blends offlavorants are used. For example, the compositions described herein caninclude two or more (e.g., two, three, four, five or more) flavorants.The flavorants described herein can be soluble and stable in water.Selection of suitable flavorants can be based on taste testing. Forexample, multiple different flavorants can be added to a compositionseparately, which are subjected to taste testing. Exemplary flavorantsinclude any fruit flavor powder (e.g., peach, strawberry, mango, orange,apple, grape, raspberry, cherry or mixed berry flavor powder). In someembodiments, any of the compositions described herein includes about0.5% to about 1.5% w/w (e.g., about 1% w/w) of a mixed berry flavorpowder. In some embodiments, any of the compositions described hereinincludes about 5% to about 7% w/w (e.g., about 6.3% w/w) of a maskingflavor. Suitable masking flavors can be obtained from e.g., Firmenich.

Silica

Some embodiments of any of the compositions provided herein furtherinclude silicon dioxide (or silica). Addition of silica to thecomposition can prevent or reduce agglomeration of the components of thecomposition. Silica can serve as an anti-caking agent, adsorbent,disintegrant, or glidant. In some embodiments, the compositionsdescribed herein include about 0.05% to about 2% w/w (e.g., about 0.05%to about 1.5%, about 0.07% to about 1.2%, or about 0.08% to about 0.1%,e.g., 0.09% w/w) porous silica. Porous silica can, for example, have ahigher H₂O absorption capacity and/or a higher porosity as compared tofumed silica, at a relative humidity of about 20% or higher (e.g., about25%, 30%, 35%, 40%, 45%, 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, or95% or higher). In some embodiments, the porous silica have an H₂Oabsorption capacity of about 5% to about 40% (e.g. about 20% to about40%, or about 30% to about 40%) by weight at a relative humidity ofabout 50%. The porous silica can have a higher porosity at a relativehumidity of about 20% or higher (e.g., about 30%, 40%, 50%, 60%, 70%,80%, 90% or higher) as compared to that of fumed silica. In someembodiments, the porous silica have an average particle size of about 2pm to about 10 pm (e.g. about 3 pm to about 9 pm, about 4 pm to about 8pm, about 5 pm to about 8 pm, or about 7.5 pm). In some embodiments, theporous silica have an average pore volume of about 0.1 cc/gm to about2.0 cc/gm (e.g., about 0.1 cc/gm to about 1.5 cc/gm, about 0.1 cc/gm toabout 1 cc/gm, about 0.2 cc/gm to about 0.8 cc/gm, about 0.3 cc/gm toabout 0.6 cc/gm, or about 0.4 cc/gm). In some embodiments, the poroussilica have a bulk density of about 50 g/L to about 700 g/L (e.g. about100 g/L to about 600 g/L, about 200 g/L to about 600 g/L, about 400 g/Lto about 600 g/L, about 500 g/L to about 600 g/L, about 540 g/L to about580 g/L, or about 560 g/L). In some embodiments, the compositionsdescribed herein include about 0.05% to about 2% w/w (e.g., anysubranges of this range described herein) of Syloid® 63FP (WR Grace).

Buffering Agents and Lubricants

Some embodiments of any of the compositions described herein furtherinclude one or more buffering agents. In some embodiments, thecomposition includes about 0.5% to about 5% w/w (e.g., about 1% to about4%, about 1.5% to about 3.5%, or about 2% to about 3%, e.g. about 2.7%w/w) of buffering agents. Buffering agents can include weak acid or basethat maintain the acidity or pH of a composition near a chosen valueafter addition of another acid or base. Suitable buffering agents areknown in the art. In some embodiments, the buffering agent in thecomposition provided herein is a phosphate, such as a sodium phosphate(e.g., sodium phosphate dibasic anhydrous). For example, the compositioncan include about 2.7% w/w of sodium phosphate dibasic.

Some embodiments of any of the compositions described herein furtherinclude one or more lubricants. In some embodiments, the compositionincludes about 0.05% to about 1% w/w (e.g., about 0.1% to about 0.9%,about 0.2% to about 0.8%, about 0.3% to about 0.7%, or about 0.4% toabout 0.6%, e.g. about 0.5% w/w) of lubricants. Exemplary lubricantsinclude, but are not limited to sodium stearyl fumarate, magnesiumstearate, stearic acid, metallic stearates, talc, waxes and glycerideswith high melting temperatures, colloidal silica, polyethylene glycols,alkyl sulphates, glyceryl behenate, and hydrogenated oil. Additionallubricants are known in the art. In some embodiments, the compositionincludes about 0.05% to about 1% w/w (e.g., any of the subranges of thisrange described herein) of sodium stearyl fumarate. For example, thecomposition can include about 0.5% w/w of sodium stearyl fumarate.

Additional suitable sweeteners or taste masking agents can also beincluded in the compositions described herein, such as but not limitedto, xylose, ribose, glucose, mannose, galactose, fructose, dextrose,sucrose, maltose, steviol glycosides, partially hydrolyzed starch, andcorn syrup solid. Water soluble artificial sweeteners are contemplatedherein, such as the soluble saccharin salts (e.g., sodium or calciumsaccharin salts), cyclamate salts, acesulfam potassium (acesulfame K),and the free acid form of saccharin and aspartame based sweeteners suchas L-aspartyl-phenylalanine methyl ester, Alitame® or Neotame®. Theamount of sweetener or taste masking agents can vary with the desiredamount of sweeteners or taste masking agents selected for a particularfinal composition.

Pharmaceutically acceptable binders in addition to those described aboveare also contemplated for the compositions described herein. Examplesinclude cellulose derivatives including microcrystalline cellulose,low-substituted hydroxypropyl cellulose (e.g. LH 22, LH 21, LH 20, LH32, LH 31, LH30); starches, including potato starch; croscarmellosesodium (i.e. cross-linked carboxymethylcellulose sodium salt; e.g.Ac-Di-Sol®); alginic acid or alginates; insoluble polyvinylpyrrolidone(e.g. Polyvidon® CL, Polyvidon® CL-M, Kollidon® CL, Polyplasdone® XL,Polyplasdone® XL-10); sodium carboxymethyl starch (e.g. Primogel® andExplotab®).

Additional fillers, diluents or binders may be incorporated such aspolyols, sucrose, sorbitol, mannitol, Erythritol®, Tagatose®, lactose(e.g., spray-dried lactose, α-lactose, β-lactose, Tabletose®, variousgrades of Pharmatose®, Microtose or Fast-Floc®), microcrystallinecellulose (e.g., various grades of Avicel®, such as Avicel® PH101,Avicel® PH102 or Avicel® PH105, Elcema® P100, Emcocel®, Vivacel®, MingTai® and Solka-Floc®), hydroxypropylcellulose, L-hydroxypropylcellulose(low-substituted) (e.g. L-HPC-CH31, L-HPC-LH11, LH 22, LH 21, LH 20, LH32, LH 31, LH30), dextrins, maltodextrins (e.g. Lodex® 5 and Lodex® 10),starches or modified starches (including potato starch, maize starch andrice starch), sodium chloride, sodium phosphate, calcium sulfate, andcalcium carbonate.

Pharmaceutical Compositions

Any of the compositions described herein can be formulated for use as orin pharmaceutical compositions. Such compositions can be formulated oradapted for administration to a subject via any route, e.g., any routeapproved by the Food and Drug Administration (FDA), such as but notlimited to oral, parenteral, or transdermal delivery. Exemplary methodsare described in the FDA's CDER Data Standards Manual, version number004 (which is available at fda.give/cder/dsm/DRG/drg00301.html).

In some embodiments, the compositions described herein is used fortreating or preventing one or more symptoms associated with aneurodegenerative disease in a subject in need thereof. Exemplaryneurodegenerative diseases include, but are not limited to amyotrophiclateral sclerosis (ALS), Alzheimer's disease, Multiple Sclerosis (MS),Parkinson's disease, Huntington's disease, Pick's Disease, Multi-InfarctDementia, Creutzfeldt-Jakob's Disease, Dementia with Lewy bodies, Mixeddementia, and frontotemporal dementia.

Any of the compositions described herein can be formulated as apharmaceutical composition that further includes one or more additionaltherapeutic agents. Exemplary additional therapeutic agents includeriluzole (CgH₅F₃N₂OS, sold under the trade names Rilutek® andTiglutik®), edaravone (sold under the trade names Radicava® andRadicut®), mexiletine (sold under the trade names Mexitil and NaMuscla),a combination of dextromethorphan and quinidine (Nuedexta®),anticholinergic medications, and psychiatric medications such as but notlimited to antidepressants, antipsychotics, anxiolytics/hypnotics, moodstabilizers, and stimulants. Any known anticholinergic medications arecontemplated herein, including but are not limited to, glycopyrrolate,scopolamine, atropine (Atropen), belladonna alkaloids, benztropinemesylate (Cogentin), clidinium, cyclopentolate (Cyclogyl), darifenacin(Enablex), dicylomine, fesoterodine (Toviaz), flavoxate (Urispas),glycopyrrolate, homatropine hydrobromide, hyoscyamine (Levsinex),ipratropium (Atrovent), orphenadrine, oxybutynin (Ditropan XL),propantheline (Pro-banthine), scopolamine, methscopolamine, solifenacin(VESIcare), tiotropium (Spiriva), tolterodine (Detrol), trihexyphenidyl,trospium, and diphenhydramine (Benadryl). Any known antidepressants arecontemplated herein as additional therapeutic agents, including but notlimited to selective serotonin inhibitors, serotonin-norepinephrinereuptake inhibitors, serotonin modulators and stimulators, serotoninantagonists and reuptake inhibitors, norepinephrine reuptake inhibitors,norepinephrine-dopamine reuptake inhibitors, tricyclic antidepressants,tetracyclic antidepressants, monoamine oxidase inhibitors, and NMDAreceptor antagonists.

The pharmaceutical compositions described herein can further include anypharmaceutically acceptable carrier, adjuvant and/or vehicle.Pharmaceutically acceptable carrier or adjuvant refers to a carrier oradjuvant that may be administered to a patient, and which does notdestroy the pharmacological activity thereof and is nontoxic whenadministered in doses sufficient to deliver a therapeutic amount of theactive compounds. Exemplary pharmaceutically acceptable carriers includesaline, solvents, dispersion media, coatings, antibacterial andantifungal agents, and isotonic and absorption delaying agents, whichare compatible with pharmaceutical administration. In some cases, the pHof the formulation may be adjusted with pharmaceutically acceptableacids, bases or buffers to enhance the stability of the formulatedcompound or its delivery form. The term parenteral as used hereinincludes subcutaneous, intracutaneous, intravenous, intramuscular,intra-articular, intraarterial, intrasynovial, intrasternal,intrathecal, intralesional and intracranial injection or infusiontechniques.

Any of the therapeutic compositions disclosed herein can be formulatedfor sale in the US, imported into the US, and/or exported from the US.The pharmaceutical compositions can be included in a container, pack, ordispenser together with instructions for administration. In someaspects, the invention provides kits that include the bile acid andphenylbutyrate compounds. The kit may also include instructions for thephysician and/or patient, syringes, needles, box, bottles, vials, etc.

Dosage and Method of Administration

Pharmaceutical compositions are typically formulated to be compatiblewith its intended route of administration. Examples of routes ofadministration include parenteral, e.g., intravenous, intradermal,subcutaneous, oral (e.g., inhalation or through a feeding tube),transdermal (topical), transmucosal, and rectal administration.

Pharmaceutical compositions can be in the form of a solution or powderfor inhalation and/or nasal administration. Such compositions may beformulated according to techniques known in the art using suitabledispersing or wetting agents and suspending agents. The sterileinjectable preparation may also be a sterile injectable solution orsuspension in a non-toxic parenterally acceptable diluent or solvent,for example, as a solution in 1,3-butanediol. Among the acceptablevehicles and solvents that may be employed are mannitol, water, Ringer'ssolution and isotonic sodium chloride solution. In addition, sterile,fixed oils are conventionally employed as a solvent or suspendingmedium.

Pharmaceutical compositions can be orally administered in any orallyacceptable dosage form including, but not limited to, powders, capsules,tablets, emulsions and aqueous suspensions, dispersions and solutions.In the case of tablets for oral use, carriers which are commonly usedinclude lactose and corn starch. For oral administration in a capsuleform, useful diluents include lactose and dried corn starch. Whenaqueous suspensions and/or emulsions are administered orally, the activeingredient may be suspended or dissolved in an oily phase is combinedwith emulsifying and/or suspending agents. If desired, coloring agentsmay be added. The solid formulation can be reconstituted in an aqueoussolvent (e.g., water, saline solution) to prepare an aqueousformulation. As used herein, the term “aqueous solvent” refers to aliquid comprising at least 50% (e.g., at least 60%, 70%, 80%, 90% or atleast 95%) water. In some embodiments, the aqueous solvent is water.

Alternatively or in addition, pharmaceutical compositions can beadministered by nasal aerosol or inhalation. Such compositions areprepared according to techniques well-known in the art of pharmaceuticalformulation and may be prepared as solutions in saline, employing benzylalcohol or other suitable preservatives, absorption promoters to enhancebioavailability, fluorocarbons, and/or other solubilizing or dispersingagents known in the art.

In some embodiments, any of the compositions described herein issubstantially dissolved in water prior to oral administration to asubject. The compositions of the present disclosure can be administeredto a subject in need thereof once a day, twice a day, or three times aday or more.

In some embodiments, the bile acid (e.g., TURSO) of the composition isadministered at an amount of about 0.5 to about 5 grams (e.g., about 0.5to about 4.5, about 0.5 to about 3.5, about 1 to about 3, e.g., about 2grams) per day. In some embodiments, the bile acid is TURSO and isadministered at an amount of about 2 grams per day, for example, onegram is administered twice a day. In some embodiments, the bile acid isadministered at about 10 mg/kg to about 50 mg/kg (e.g., about 10 mg/kgto about 40 mg/kg, about 10 mg/kg to about 30 mg/kg, about 10 mg/kg toabout 20 mg/kg, about 10 mg/kg to about 15 mg/kg, or about 13 mg/kg toabout 15 mg/kg) of the body weight of the subject.

In some embodiments, the phenylbutyrate compound (e.g., sodiumphenylbutyrate) of the composition is administered at an amount of about0.5 to about 10 grams (e.g., about 1 to about 10, about 2 to about 9,about 3 to about 8, about 5 to about 7, e.g., about 6 grams) per day. Insome embodiments, the bile acid is sodium phenylbutyrate and isadministered at an amount of about 6 grams per day, for example, threegrams is administered twice a day. In some embodiments, thephenylbutyrate compound is administered at about 10 mg/kg to about 400mg/kg (e.g., about 10 mg/kg to about 300 mg/kg, about 10 mg/kg to about200 mg/kg, about 10 mg/kg to about 100 mg/kg, about 10 mg/kg to about 80mg/kg, about 30 mg/kg to about 80 mg/kg, or about 30 mg/kg to about 50mg/kg) of the body weight of the subject.

In some embodiments, the composition is administered once a day or twicea day and each administration includes about 1 gram of TURSO and about 3grams of sodium phenylbutyrate. In some embodiments, the composition isadministered once a day and each administration contains about 2 gramsof TURSO and about 6 grams of sodium phenylbutyrate.

The composition can be administered to a subject in need thereof for atleast about six months (e.g., at least about 7, 8, 9, 10, 11, 12, 13,14, 15, 16, 16, 18, 20, 21, 22, 23, or 24 months). In some embodiments,the composition is administered to a subject in need thereof for lessthan about 6 months (e.g., less than about 5, 4, 3, 2, or 1 month).

Methods of Processing

This disclosure further relates to methods of processing ormanufacturing a pharmaceutical formulation based on dry granulation.Provided herein are methods of processing a composition, the methodsinclude: (i) roller compacting a pre-blend composition comprising sodiumphenylbutyrate and TURSO, wherein the sodium phenylbutyrate and theTURSO have a ratio by weight of about 3:1, to thereby form a compactedpre-blend; and (ii) granulating the compacted pre-blend to form granuleshaving a Carr's index of about 12 or less.

The pre-blend composition can include about 15% to about 45% w/w (e.g.,any of the subranges of this range described herein) of sodiumphenylbutyrate and about 5% to about 15% w/w (e.g., any of the subrangesof this range described herein) of TURSO.

Some embodiments of any of the methods of processing a compositiondescribed herein further include, prior to step (i), blending a firstcomposition comprising sodium phenylbutyrate and a second compositioncomprising TURSO, to form the pre-blend composition.

A step of sieving the first composition comprising sodium phenylbutyrateand the second composition comprising TURSO can be performed prior toblending. Such sieving can be carried out with any conventional sievingmeans known to the skilled person.

The first and second compositions can be blended for about an hour orless (e.g., about 55, 50, 45, 40, 35, 30, or 25 minutes or less), and/orat a blending speed of about 10 rpm to about 20 rpm (e.g., about 12 rpmto about 18 rpm, about 14 to about 16, e.g., about 15 rpm). Blendingtime and blending speed can be adjusted so as to achieve an essentiallyhomogenous admixture of components. Blending speed can either be fixedor adjusted during blending. In some embodiments, blending the first andsecond compositions for about 30 minutes or less (e.g., about 29, 28,27, or 26 minutes or less, e.g., about 25 minutes or about 15 minutes)result in less particle attrition as compared to blending thecomposition for more than 30 minutes and is therefore more desired.Suitable blending equipment and parameters are known in the art. Forexample, any apparatus typically employed in the pharmaceutical industryfor uniformly admixing two or more components, including V-shapedblenders, double-cone blenders, bin (container) blenders, and rotarydrum blenders can be used. Blender volume can be 50 L, 100 L, 200 L, 250L or greater. Before, during, or after blending, the composition mayalso be subjected to milling under suitable milling speed. Suitablemilling equipment and parameters are known in the art.

The term “roller compacting” refers to a process in which powders areforced between two counter rotating rolls and pressed into a solidcompact or ribbon. Roller compaction can be carried out with anysuitable roller compactor known to the skilled person. For example, aMACRO-PACTOR® or a MINI-PACTOR® from Gerteis can be used. The step ofgranulating the solid compact or ribbon into granules involvesmilling/sieving the compact or ribbon into desired granulate size, andcan be carried out by a roller compactor that integrates the rollercompacting and milling functions, or can be carried out on a separateequipment. “Granulating” and “milling” are used interchangeably hereinand can refer to a process of breaking solid materials into smallerpieces, for example, by grinding, crushing, or cutting.

A roller compactor can generally consist of three major units: a feedingsystem, which conveys the powder to the compaction area between therolls; a compaction unit, where powder is compacted between two counterrotating rolls to a ribbon by applying a force; and a size reductionunit, for milling the ribbons to the desired particle size.

Several operational parameters can be adjusted/controlled to modify theproduct granulate, including the compaction force, the gap width and thegranulation screen size. The compaction force can be expressed in kN/cm,which refers to the force per cm roll width. The gap width refers to thewidth of the gap between the two of the rotating rollers. As the gapwidth increases, the constant force applied by the roller has to betransmitted through a thicker ribbon of powder and thus the ribbon mayhave a lower strength and will likely result in smaller, weaker granulesfollowing the milling process. Additional descriptions of the rollercompaction processing variables can be found in e.g. Freeman et al.,Asian Journal of Pharmaceutical Sciences 11:516-527, 2016.

The compaction force used in step (i) can be about 5 kN/cm to about 15kN/cm (e.g., about 7 kN/cm to about 13 kN/cm, about 8 kN/cm to about 12kN/cm, or about 9 kN/cm to about 11 kN/cm, e.g., about 10 kN/cm). Insome embodiments of any of the methods described herein, step (i) caninclude roller compacting the pre-blend composition between at least tworotating rolls having a gap width of about 1 mm to about 5 mm, about 2mm to about 4 mm, or about 2 mm to about 3 mm. The rotating rolls canhave a roll speed of about 4 rpm to about 12 rpm (e.g. about 5, 6, 7, 8,9, 10, or 11 rpm). Roller compaction can be performed at a temperaturethat prevents melting or agglomeration of the composition. For example,the pre-blend composition can be roller compacted at a temperature ofabout 10° C. to about 30° C. (e.g., about 12° C. to about 30° C., about12° C. to about 20° C., or about 12° C. to about 18° C., about 15° C. toabout 25° C., about 20° C. to about 30° C., or about 24° C. to about 29°C.). A cooling unit set to a temperature of about 10° C. to about 20° C.(e.g., about 12° C. to about 18° C., or about 13° C. to about 17° C.)can be added to the roller compactor for this purpose. The rotatingrolls can, for example, have a temperature of about 10° C. to about 30°C. (e.g., any of the subranges within this range described herein).

In some embodiments of any of the methods described herein, step (ii)includes granulating the compacted pre-blend to form granules. Agranulation screen with a diameter of about 0.8 mm to about 2 mm (e.g.,about 1 mm to about 1.8 mm, about 1.2 mm to about 1.7 mm, about 1.4 mmto about 1.6 mm or e.g. about 1.5 mm) can be used. The methods can alsoinclude a step of sieving the granules by at least one suitable meshsize.

The methods described herein can further include a step of finalblending, following step (ii), which includes blending the granules for10 minutes or less, or 5 minutes or less.

The granules prepared by the present methods can have a bulk density ofabout 0.2 g/mL to about 1.0 g/mL (e.g., about 0.2 g/mL to about 0.9g/mL, about 0.3 g/mL to about 0.8 g/mL, or about 0.5 g/mL to about 0.7g/mL). Bulk density of the granules can be determined using methodsknown in the art, for example, by pouring the granules into a graduatedcylinder of a suitable size.

The granules prepared by the present methods can have a tapped densityof about 0.5 g/mL to about 1.2 g/mL, or about 0.7 g/mL to about 0.9g/mL. Tapped density of the granules can be determined using methodsknown in the art, for example, using a tapped volumeter to compact thegranules using 100-tap increments until volume change was less than 5%.

The granules prepared by the methods described herein can have animproved flowability (e.g., as reflected by Carr's index, Hausner ratio,angle of repose, or bulk and/or tapped density) compared to thepre-blend composition of step (i). The granules can also have animproved flowability compared to the first composition comprising sodiumphenylbutyrate and/or the second composition comprising TURSO. In someembodiments, the granules prepared by the present methods have a Carr'sindex of about 12 or less (e.g., a Carr's index of about 1 to 12, e.g.,about 11, 10, 9, 8, 7, 6, or about 5). The processing methods describedherein can result in a decrease of at least about 3 (e.g., at leastabout 4, 5, 6, 7, 8, or 10) in the Carr's index of the granules formedin step (ii) as compared to the Carr's index of the pre-blendcomposition from step (i).

In some embodiments of any of the methods of processing a compositionprovided herein, the dissolution time for releasing about 75% of theTURSO in the granules formed in step (iii) is between about 0.5 to about15 minutes (e.g., between about 0.5 to about 10 minutes, between about0.5 to about 8 minutes, or between about 0.5 to about 5 minutes). Insome embodiments, the dissolution time for releasing about 75% of thesodium phenylbutyrate in the granules formed in step (iii) is betweenabout 0.5 to about 15 minutes (e.g., between about 0.5 to about 10minutes, between about 0.5 to about 8 minutes, or between about 0.5 toabout 5 minutes). Methods of determining dissolution time of a compoundcan be determined using methods known in the art.

In some embodiments of any of the methods of processing a compositionprovided herein, the composition further includes about 8% to about 24%w/w (e.g., any of the subranges of this range described herein) ofdextrates; about 1% to about 6% w/w (e.g., any of the subranges of thisrange described herein) of sugar alcohol (e.g., any of the sugaralcohols described herein or known in the art, e.g. sorbitol); and about22% to about 35% w/w (e.g., any of the subranges of this range describedherein) of maltodextrin. The composition can further include about 0.5%to about 5% w/w (e.g., any of the subranges of this range describedherein) of sucralose, about 2% to about 15% w/w (e.g., any of thesubranges of this range described herein) of one or more flavorants,about 0.05% to about 2% w/w (e.g., any of the subranges of this rangedescribed herein) of porous silica, about 0.5% to about 5% w/w (e.g.,any of the subranges of this range described herein) of a bufferingagent (e.g., any of the buffering agents described herein or known inthe art, e.g. sodium phosphate), and/or about 0.05% to about 1% w/w(e.g., any of the subranges of this range described herein) of one ormore lubricants (e.g., any of the lubricants described herein or knownin the art, e.g. sodium stearyl fumarate).

EXAMPLES

Additional embodiments are disclosed in further detail in the followingexamples, which are provided by way of illustration and are not in anyway intended to limit the scope of this disclosure or the claims.

Example 1: Flow Optimization by Alteration of Sorbitol, Dextrates andSodium Phosphate Type

The following experiments were conducted to develop and optimize theformulation and related processes to produce a final dosage formcontaining dual active pharmaceutical ingredients (APIs, TURSO and NaPB)and taste-blinded placebos. Formulation development involvedoptimization of blend flow properties using various excipients,taste-masking of active and placebo blends, and moisture control usingexcipients and processing techniques. A placebo formulation mimickingthe active formulation in both appearance and taste was developed usinga similar process.

As both APIs were determined to be poorly flowing which would increasethe difficulty of automated processing during scale up and production,flow optimization was conducted by blending the APIs with better flowingexcipients with the dual purpose of both improving blend flow forprocessing and taste-masking the APIs.

Materials and Equipment

TABLE 1 Materials used for characterization of flow propertiesManufacturer Material Brand Grade Manufacturer Lot# TURSO — — ProdottiChimici 2015010026 E Alimentari S.p.A. NaPB — — Sri Krishna SPB013/14-15Pharmaceuticals limited Sodium Phosphate Monobasic — ACS Fisher Chemical116745 Monohydrate Sodium Phosphate Dibasic — ACS Amresco 2934C448Anhydrous Dextrates Emdex NF JRS Pharma EX13K42DX Sorbitol NeosorbUSP/NF/EP/JP Roquette US061 P110 Sucralose — HPLC Sigma Life BCBH2029VScience Colloidal Silica Aerosil USP/NF/EP/JP Spectrum RM-08L13 200Magnesium Stearate Ligamed USP/NF/EP/JP Peter Greven C401433 MF-2-K

TABLE 2 Equipment Equipment Manufacturer Model Sieve Shaker W.S. TylerRX86 Sieves Fischer Scientific E-11 spec Tapped Volumeter Erweka SVM22LOD Denver Instruments IR-30

TABLE 3 Blends with varying sorbitol and dextrate amounts Target Weights(x2 sachets) Formulation # Formulation % Material Lot # A B C A B CTURSO 2015010026 2 2 2 14.7 12.8 11.3 NaPB (Sri Krishna SPB013/14-15 6 66 44 38.4 34 Pharmaceuticals limited) Monosodium phosphate 116745 0.560.56 0.56 4.1 3.58 3.17 monohydrate (Fisher Chemical) Disodiumphosphate, 2934C448 0.784 0.784 0.784 5.75 5.01 4.44 anhydrous (Amresco)Dextrates, hydrated EX13K42DX 3.2 4.8 6.4 23.5 30.7 36.3 (Emdex NF)Sorbitol (Neosorb p110) US061 0.8 1.2 1.6 5.86 7.67 9.07 Sucralose(Sigma Life BCBH2029V 0.02 0.02 0.02 0.15 0.13 0.11 Science, 69293-100g) Aerosil 200 (Evonik) RM-08L13 0.16 0.16 0.16 1.17 1.02 0.91 MagnesiumStearate C401433 0.12 0.12 0.12 0.88 0.77 0.68 (Peter Greven, LigamedMF-2-k) Total: 13.64 15.64 17.644 100 100 100

Results

Formulations A, B, and C were prepared which contain varying sorbitoland dextrate amounts. The formulations were then subjected to thefollowing analyses.

Particle Size Distribution

Sample blends were analyzed using a W.S. Tyler RX86 sieve shaker fittedwith #60, 80, 100, 140, 200, 325, or 400 mesh screens. 10 g of each APIwas placed into the topmost sieve and was agitated for 5 minutes, afterwhich the amount of API collected in each sieve was measured andrecorded. The particle size distribution of NaPB and TURSO are shown inFIG. 1 .

Hausner Ratio and Carr's Index

Bulk density was calculated for each API and blend by gently pouringpowder into a 25 mL graduated cylinder. Tapped density was calculatedusing a tapped volumeter to compact each powder using 100-tap incrementsuntil volume change was <5%. Hausner ratio and Carr's index were thencalculated using bulk density and tapped density. The Carr's index ofthe APIs and formulations A-C are shown in Table 4 below. Formulation Cwas selected based on flow characteristics. Carr's index, in addition tobeing a measure of compressibility, may also be used to determine theflow properties of a material. A high Carr's index (large difference inbulk versus tapped densities) indicates that the material has strongerintermolecular forces which reduces flowability. Acceptable flowproperty (as determined by the packaging equipment used) was a minimumof a Carr's index of under 25, with a Carr's index of below 20 beingpreferable.

TABLE 4 Carr's index of APIs and blends Flow Carr's FormulationFormulation Formulation characteristic index NaPB TURSO A B C Excellent<10 — — — — — Good 11-15 — — — — — Fair 16-20 — — — — 19.2 Passable21-25 — 24.2 21.5 23.1 — Poor 26-31 — — — — — Very poor 32-37 — — — — —very very poor >38 39.2 — — — —

Angle of Repose

Next, flowability of formulation C was measured using angle of repose,determined by allowing powder to fall from a fixed-height funnel onto aflat surface. Angle of repose was calculated using the radius of thebase of the pile and the height. The angle of repose for formulation Cwas determined to be 31.1. For reference, the flow characteristics thatcorrespond with a certain range of angle of repose are shown in Table 5below.

TABLE 5 Angle of Repose and flow characteristics Angle of Repose Flowcharacteristic 25-30 Excellent 31-35 Good 36-40 Fair 41-45 Passable46-55 Poor - must vibrate 56-65 Very poor >66 very very poor

Blend Agglomeration

After storage in sealed bottles for about one week, slight agglomerationof blends was observed. Results from loss-on-drying (LOD) testing ofsorbitol and dextrates showed that neither exhibited massive wateruptake, and they were unlikely to be the cause for agglomeration.

Prior to finalizing the formulation, dibasic sodium phosphate in theformulation was changed from anhydrous to heptahydrate, due to concernsthat the anhydrous form was more hygroscopic than the heptahydrate form.

Formulation Selection

Sorbitol and dextrate levels from formulation C were selected due tosignificant improvements in flow properties as measured by angle ofrepose and Carr's index.

Example 2: Taste Masking Optimization

To produce a palatable dosage form that could be consumed by patientswith possible motor impairment, a powder for reconstitution dosage formwas selected and various sweeteners and flavors were investigated fortaste masking.

Materials

TABLE 6 Materials for taste masking optimization Material Lot #Manufacturer TURSO 2015010026 Prodotti Chimici E Alimentari S.p.A. NaPBSPB013/14-15 Sri Krishna Pharmaceuticals Sodium phosphate monobasic,monohydrate 116745 Fisher Chemical Sodium phosphate dibasic, anhydrous2934C448 Amresco Dextrates, hydrated (Emdex NF) EX13K42DX JRS PharmaSorbitol (Neosorb p110) US061 Roquette Sucralose (69293-100 g) BCBP3048VSigma Life Science Aerosil 200 RM-08L13 Evonik 26-04-0026SD1 PeachFlavor Powder (Nat & Art) 021716 Edgar A. Weber & Co. 28-05-0050SD1Peach Flavor Powder (MWNI) 010616 Edgar A. Weber & Co. 28-98-0014SD1Strawberry Flavor Powder (MWNI) 012516 Edgar A. Weber & Co.30-86-0184SD1 Strawberry Flavor Powder (Art) 072815 Edgar A. Weber & Co.20-85-4724SD1 Orange Flavor Powder (Nat) 021716 Edgar A. Weber & Co.26-01-0120SD2 Orange Flavor Powder (Nat & Art) 080715 Edgar A. Weber &Co. 26-03-0039SD1 Mango Flavor Powder (Nat & Art) 021716 Edgar A. Weber& Co. 28-11-0058SD1 Mango Flavor Powder (MWNI) 011916 Edgar A. Weber &Co. 30-98-0057SD1 Apple Flavor Powder (Art) 072915 Edgar A. Weber & Co.22-97-0119SD2 Apple Flavor Powder (WONF) 030216 Edgar A. Weber & Co.F4538 Grape Flavor Powder (Art) 45383316 Foote & Jenks Hawaiian PunchFlavor Powder (Nat) 158D12 Prinova S Blue Raspberry Flavor Powder (Nat &Art) 113D01 Prinova Mixed Berry Flavor Powder (Nat) 118D01 PrinovaCherry Flavor Powder (Nat & Art) 186D01 Prinova 28-03-0212SD1 MixedBerry Flavor Powder 031516 Edgar A. Weber & Co. (MWNI) Kleptose LinecapsMaltodextrin E436F Roquette

Results Sucralose Level Optimization

Formulation C was produced with varying levels of sucralose(formulations C₁-C₃) for taste masking. The compositions of formulationsC₁-C₃ are shown in Table 7. Formulation C1 was selected based on besttaste-masking performance.

TABLE 7 Sucralose formulation compositions Form C1 Form C2 Form C3Material (0.5% (0.3% (0.1% (Formulation C) sucralose) C1 by % sucralose)C2 by % sucralose) C3 by % TURSO 1.0000 14.74% 1.0000 14.77% 1.000014.80% NaPB 3.0000 44.21% 3.0000 44.30% 3.0000 44.39% Sodium phosphate0.2800 4.13% 0.2800 4.13% 0.2800 4.14% monobasic, monohydrate Sodiumphosphate 0.3920 5.78% 0.3920 5.79% 0.3920 5.80% dibasic, anhydrousDextrates, hydrated 1.6000 23.58% 1.6000 23.63% 1.6000 23.67% Sorbitol0.4000 5.89% 0.4000 5.91% 0.4000 5.92% Aerosil 200 0.0800 1.18% 0.08001.18% 0.0800 1.18% Subtotal: 6.7520 99.50% 6.7520 99.70% 6.7520 99.90%Sucralose 0.0339 0.50% 0.0203 0.30% 0.0068 0.10% Total: 6.7859 100.00%6.7723 100.00% 6.7588 100.00%

Flavoring Selection

Bulk active blend was prepared and dissolved in about 250 mL water perdosage unit. Several flavoring agents were added in varyingconcentrations in addition to Kleptose Linecaps Maltodextrin until thedesired level of taste-masking was reached. The final flavors andsweetener concentrations were selected based on taste optimization.

Maltodextrin Use and Updated Formulation

To maintain the formulation as having around 10 g of total material withthe addition of flavorants and maltodextrin, all other materials (exceptAPI) were adjusted and formulation C1 was further modified. Further,dibasic sodium phosphate in the formulation was changed from anhydrousto heptahydrate, due to concerns that the anhydrous form was morehygroscopic than the heptahydrate form. The modified formulation C1 isshown in Table 8 below.

TABLE 8 Modified formulation C1 Modified formulation C1- 1 Material(Modified % Composition sachet (0.5% formulation C1) (W/W) sucralose)TURSO 9.35% 1 NaPB 28.06% 3 Sodium phosphate 2.62% 0.28 monobasic,monohydrate Sodium phosphate 6.92% 0.74 dibasic, Heptahydrate Dextrates,hydrated 14.96% 1.6 Sorbitol 3.74% 0.4 Aerosil 200 0.75% 0.08 Sucralose0.50% 0.0535 Mixed Berry Flavoring 3.10% 0.331223 (0.14%W/V) Subtotal:70.00% 7.484723 Kleptose Linecaps 30.00% 3.207738429 (Maltodextrin)Total: 100.00% 10.69246143

Of note, flow characteristics remained substantially stronger than theflow of the APIs suggesting that this altered formulation was stillsuccessful at improving flow. The Carr's index for the modifiedformulation C1 was 22.3, with the angle of repose being 34.4. Forreference, the flow characteristics that correspond with a certain rangeof angle of repose are shown in Table 5 above; the flow characteristicsthat correspond with a certain range of Carr's index are shown in Table9.

TABLE 9 Carr's index and Flow Characteristics Carr's index Flowcharacteristic <10 Excellent 11-15 Good 16-20 Fair 21-25 Passable 26-31Poor 32-37 Very poor >38 very very poor

Results

Addition of specific flavorants and maltodextrin as well as levels ofsucralose were tested to ensure optimal taste masking. Further, additionof these agents did not impact the improved flowability achieved inExample 1.

Example 3: Agglomeration Discovery and Prevention Materials andEquipment

TABLE 10 Active Stability Materials Manufacturer Material Brand GradeManufacturer Lot# TURSO — — Prodotti Chimici 2015010026 E AlimentariS.p.A. NaPB — — Sri Krishna SPB026/14-15 Pharmaceuticals SodiumPhosphate Monobasic — ACS Amresco 1575C229 Monohydrate Sodium PhosphateDibasic — ACS Amresco 3606C403 Heptahydrate Dextrates, hydrated Emdex NFJRS Pharma EX13K42DX Sorbitol Neosorb USP/NF/EP/JP Roquette US061 P110Sucralose HPLC Sigma Life BCBP3048V Science Colloidal Silica AerosilUSP/NF/EP/JP Spectrum 1DK0436 200 Maltodextrin, Lab4118 Kleptose EPRoquette E436F Linecaps Mixed Berry Flavor Powder 28-03- — Edgar A.Weber 031516 (MWNI) 0212SD1 & Co.

TABLE 11 Equipment used for active stability lot production EquipmentManufacturer Model Blender Bohle LM40 w/5 L bin

TABLE 12 Equipment used for analysis of batch failure EquipmentManufacturer Model LOD Denver Instruments IR-30 Stability ChamberEnvironmental ES2000/ES2000 Specialties Reach-in

Results

Storing the blend for −36 hours inside a sealed Bohle Blender 5 L Binresulted in agglomeration and difficulties in dispensing the blend. Toprevent agglomeration and further improve blend stability, theagglomerated blend was manually removed and placed in a 50° C. dryingoven and subjected to Loss on Drying (LOD) testing.

Loss on Drying (LOD) Testing

LOD testing was performed on recovered agglomerated blend(PD2016-015-33B) after ˜2 hours of drying at 50° C. to determine thedegree of moisture uptake. Results were compared against anon-agglomerated blend that had been stored in a sealed bottle(PD2016-015-29A). The results of the LOD testing are shown in Table 13.

TABLE 13 LOD of Active Blends Sample % Loss on Time Blend BatchWeight(g) Drying (min) PD2016-015-33B 2.044 5.72 7.7 (agglomerated)2.215 5.6 4.7 2.121 6.22 7.1 2.09 6.22 10 PD2016-015-29A 2.234 4.59 6.92.205 4.63 7.4

Dynamic Vapor Sorption (DVS) Testing

Samples of NaPB, TURSO, and modified formulation C1 blend were subjectedto DVS testing to determine the magnitude of weight gain due tohumidity. The DVS isotherm plots for NaPB and TURSO are shown in FIGS. 2and 3 , respectively. The results showed that above 45% RH, NaPBexhibited massive fluctuations in mass. These changes in mass were alsoreflected in the active blend (as shown in FIG. 4 ), and were believedto contribute to the observed agglomeration.

Effect of Humidity on APIs Separately and Combined

Samples of NaPB, TURSO, and a blend of both were stored in open topvials at 25° C./60% RH for ˜60 hours, after which the vials were removedand observations recorded.

Agglomeration occurred in blends containing both APIs upon moistureuptake. Fluctuations in the mass of NaPB up to 50% and agglomerationpresents processing and dosing difficulties as moisture uptake wouldresult in changes in potency, and agglomerated material would be limitedin its ability to blend and flow during processing. Since agglomerationwas only observed when the two APIs were exposed to each other in thepresence of moisture, prevention of moisture uptake or separation ofAPIs were needed to reduce agglomeration. The following experiments wereperformed with the aim of reducing agglomeration.

Equilibration and Roller Compaction Materials and Equipment

TABLE 14 Materials for equilibration Study Manufacturer Material BrandGrade Manufacturer Lot# TURSO — — Prodotti 2015010026 Chimici EAlimentari S.p.A. NaPB — — Sri Krishna SPB026/14-15 PharmaceuticalsSodium Phosphate Monobasic — ACS Amresco 1575C229 Monohydrate SodiumPhosphate Dibasic — ACS Amresco 3606C403 Heptahydrate Dextrates,hydrated Emdex NF JRS Pharma EX13K42DX Sorbitol Neosorb USP/NF/EP/JPRoquette US782 P110 Colloidal Silica Aerosil USP/NF/EP/JP Spectrum1DK0436 200 Maltodextrin, Lab4118 Kleptose EP Roquette E436F LinecapsMixed Berry Flavor Powder 28-03- — Edgar A. Weber 031516 (MWNI) 0212SD1& Co.

TABLE 15 Equipment for equilibration Study Equipment Manufacturer ModelBlender Bohle LM40 w/5 L bin Comil Conical Mill Quadro 197 Sieve (#30mesh) Fischer Scientific E-11 spec Roller Compactor Gerteis Mini-PactorHeat Sealer Midwest Pacific MP-12 Karl Fischer Coulometer Mettler ToledoDL32 Coulometer

Equilibration

API equilibration: To test whether equilibration could prevent lateragglomeration, the APIs were allowed to equilibrate to ambientconditions. Briefly, the APIs were laid out in 2 separate trays toequilibrate. Samples were taken at T=0, 1, 2, 3, 4, and 24 hours andsealed into headspace vials for analysis by Karl Fischer Titration. Thisstudy was performed to determine the rate of moisture absorption foreach API and to determine if pre-equilibrated APIs would result in lessagglomeration due to reduced moisture uptake after blending.Water content analysis by Karl Fischer Titration: Each sample wasanalyzed for water content using Karl Fischer Titration. Equilibrationwas determined when RSD was found to be <10% between two consecutivetime points.Blending Parameters: Each batch was blended for 20 minutes, milled, andthen blended an additional 20 minutes at 25 RPM. For milling, a QuadroComil fitted with a scalloped 1016 conical mesh screen was operated at30% power. Non-granulated test sachets were filled.

Roller Compaction

Dry granulation by roller compaction of the active blend was performed.The remaining blend was roller compacted at 7.5 and 10 kN. Test sachetsof each granulation condition were filled to observe the behavior ofgranulated and non-granulated samples in packaging over time. Table 16below shows the roller compaction parameters used.

TABLE 16 Roller compaction parameters Parameter Setting Press Force7.5/10 kN Roll Speed 3 RPM Gap Size 2.5 mm Granulation Screen 2.0 mmGranulation Speed 10/20 RPM

Results from the equilibration study demonstrated that equilibrationsurprisingly had no significant effect on API moisture content. Allblends and granules agglomerated over time; however, 10 kN granulesshowed the least agglomeration and best recovery from sachets,suggesting that roller compaction surprisingly resulted in largeimprovements in agglomeration prevention.

Example 4: Silica Processing Study for Agglomeration Prevention

A study was also performed to determine if agglomeration was due tointeractions between the two APIs and if porous silica could be used toreduce agglomeration by controlling local moisture. Tables 17 and 18below show the materials used for the separate API processing and silicastudy.

TABLE 17 Materials for Separate API Processing/Silica Study ManufacturerMaterial Brand Grade Lot # Manufacturer TURSO — — 2016020063 ProdottiChimici E Alimentari S.p.A. NaPB — — SPB013/14-15 Sri KrishnaPharmaceuticals Sodium phosphate dibasic, — ACS 2934C448 AmrescoAnhydrous Dextrates, hydrated Emdex NF EX13K42DX JRS Pharma SorbitolNeosorb USP/NF/EP/JP US782 Roquette P110 Sucralose (69293-100 g) HPLCBCBP3048V Sigma Life Science Colloidal Silica Aerosil USP/NF/EP/JP1DK0436 Spectrum 200 Silica Syloid USP/NF 5210156995 Grace 244FPMaltodextrin, Lab4118 Kleptose EP E436F Roquette Linecaps Mixed BerryFlavor Powder 28-03- — 031516 Edgar A. Weber & Co. (MWNI) 0212SD1 SodiumStearyl Fumarate Pruv NF 1298X JRS Pharma Silica Syloid USP/NF5210151493 Grace 63FP

TABLE 18 Equipment for Separate API Processing/Silica Study EquipmentManufacturer Model Roller Compactor Gerteis Mini-Pactor Tapped VolumeterErweka SVM22 Heat Sealer Midwest Pacific MP-12 Sieve Shaker W.S. TylerRX86 Sieves Fischer Scientific E-11 spec

Each API was blended and roller compacted with excipients separately todetermine if the proximity of the dual APIs in the blend or granules wasresponsible for agglomeration. The resulting granules were thenrecombined and blended before filling test sachets. Bulk and tappeddensities of each blend were measured prior to roller compaction. Forthis experiment, all silica were used at 100 W/W. Aerosil 200 was usedas a negative control while Syloid 244FP and Syloid 63FP were used toremove moisture from the APIs to determine if APIs would agglomeratewith reduced local levels of water. The flow characterization of theblends are shown in Table 19 below.

TABLE 19 Flow Characterization of Silica Study Blends 1% Syloid 244FP 1%Aerosil 200 1% Syloid 244FP (TURSO) Bulk Density 0.4906 0.5313 0.6429(g/mL) Tapped 0.6500 0.6846 0.8372 Density (g/mL) Hausner Ratio 1.32501.2885 1.3023 Carr Index 24.5283 22.3881 23.2143 1% Syloid 244FP 1%Syloid 63FP 1% Syloid 63 FP (NaPB) (TURSO) (NaPB) Bulk Density 0.55170.6032 0.5079 (g/mL) Tapped 0.6809 0.8130 0.6400 Density (g/mL) HausnerRatio 1.2340 1.3478 1.2600 Carr Index 18.9655 25.8065 20.6349

Particle Size Distribution

Particle size distribution was used as a measure of agglomeration asagglomerated particles would be unable to pass through smaller sievesizes, resulting in a distribution skewed towards larger particles.Sieve shaker analysis was performed at T=7 days for each test condition.The results are shown in FIG. 5 .

Angle of Repose

Flowability as measured by angle of repose was used to determinerelative degree of agglomeration for each condition. As flowability wasseen to decrease in agglomerated samples, a low angle of repose couldsignify low levels of agglomeration and better recovery from packagingof the final product. Angle of repose measurements were taken for eachtest condition at T=4 (Table 20).

TABLE 20 Angle of Repose at T = 4 Flow Angle Aerosil 200 Syloid 244FPSyloid 244FP Aerosil 200 Syloid 63FP Syloid 244FP Characteristic ofRepose (no RC) (no RC) (10 kN) (10 kN) (Separate, 10 kN) (Separate, 10kN) Excellent 25-30 — — — — — — Good 31-35 35.69 35.71 34.38 33.05 31.8334.05 Fair 36-40 — — — — — — Passable 41-45 — — — — — — Poor- MustVibrate 46-55 — — — — — — Very Poor 56-65 — — — — — — Very, VeryPoor >66 — — — — — —

Results

Originally, Aerosil 200, a form of silica was used in the formulationresulting in angle of repose of 35.69. Switching this material to syloid63FP and roller compacting at 10 kN press force resulted in an 11%improvement in flow. Surprisingly, a different syloid product, syloid244FP did not produce the same improvement. As a result of theseexperiments, aerosol 200 was switched out of the formulation in exchangefor syloid 63FP and roller compaction was added to the process. Giventhe detrimental effects of agglomeration for processing, the 11%improvement represented a significant and surprising advance.

Example 5: Production of Stability/Tooling Batches for ActiveFormulation

Active Formulation Blending and Roller Compaction: Tables 21 and 22 showthe materials and equipment used for active formulation blending androller compaction. Table 23 shows the active formulation.

TABLE 21 Manufacturer Material Brand Grade Manufacturer Lot# TURSO — —Prodotti Chimici 2016020063 E Alimentari S.p.A. NaPB — — Sri KrishnaSPBOU/15-16 Pharmaceuticals limited Sodium Phosphate Dibasic — ACSAmresco 3536C204 Anhydrous Dextrates Emdex NF JRS Pharma EX15J37DSorbitol Neosorb USP/NF/EP/JP Roquette US453 P110 Sucralose — HPLC SigmaLife BCBP3048V Science Silica Syloid USP/NF Grace 5210151493 63FPMaltodextrin Kleptose EP Roquette E436F Linecaps Mixed Berry FlavorPowder 28-03- — Edgar A. Weber 1609834 (MWNI) 0212SD1 & Co. SodiumStearyl Fumarate Pruv NF JRS Pharma 1298X

TABLE 22 Equipment Manufacturer Model Sieve (#30 mesh) FischerScientific E-11 spec Blender (w/20 L bin) Bohle LM40 Comil Conical MillQuadro 197 Roller Compactor Gerteis Mini-Pactor Heat Sealer MidwestPacific MP-12

TABLE 23 Material (Active % Composition Active Blend-x1 Blend-1salt)(W/W) (unit: gram) TURSO 10.29% 1.0000 NaPB 30.86% 3.0000 Sodiumphosphate dibasic, 2.88% 0.2800 Anhydrous Dextrates, hydrated 16.46%1.6000 Sorbitol 4.11% 0.4000 Syloid 63FP (1%) 1.00% 0.0971 Sucralose(0.5%) 0.50% 0.0485 Sodium Stearyl Fumarate (0.5%) 0.50% 0.0485 MixedBerry Flavoring (0.14% W/V) 3.41% 0.3312 Subtotal: 70.00% 6.8053Kleptose Linecaps (30%) 30.00% 2.9166 Total: 100.00% 9.7219

All materials were weighed, sieved (#30 mesh) and layered into a 20 Lblender bin before blending for 30 minutes at 25 RPM. Blender contentswere discharged and milled using a Quadro Comil operating at 30% speedand fitted with a 1016 scalloped mesh conical screen. Following milling,the blend was placed back into the blender bin to blend for anadditional 30 minutes at 25 RPM. During the final 30 minutes ofblending, blend uniformity samples were taken at 10 minute intervals andanalyzed by HTPLC for API content. Once RSD was shown to be >500 anddrug load values were within 90-110%, the blend was roller compactedusing the parameters shown in Table 24 below. Under these parameters, abatch was successfully produced.

TABLE 24 Roller Compaction Parameters Parameter Setting Press Force7.5/10 kN Roll Speed 3 RPM Gap Size 2.5 mm Granulation Screen 2.0 mmGranulation Speed 10/20 RPM

Example 6: Further Flavor Optimization

While the flavor optimization in Example 2 substantially improved taste,a follow-up set of experiments were conducted to determine if tastecould be even further improved.

Additional Flavorants

A series of new flavorants were tested, including mango, strawberry,masking flavor and mixed berry flavor. After additional taste testing, acombination of the masking flavor and mixed berry flavors was determinedto be optimal for masking the taste of the APIs. The result was asubstantial improvement over formulation C1, which was developed duringthe initial round of formulation development.

Additional Sucralose

Following the change in flavorants, the level of sucralose was furtheradjusted and subjected to taste testing. It was determined thatadditional sucralose further improved/masked the taste of the APIs, andthe sucralose level was revised to 200 mg per unit dose.

Formulation D

With the above changes, the formulation was revised to formulation D(Table 25) which had improved taste characteristics.

TABLE 25 Formulation D Milligram per Material unit dose wt % NaPB3000.000 29.2% TURSO 1000.000  9.7% Dextrates Hydrated NF (EMDEX NONGMO) 1600.000 15.6% Sorbitol NF (NEOSORB P110) 400.000  3.9% SucraloseNF/PH. EUR 200.000  1.9% Silicon Dioxide NF (Syloid 63FP)-CTM 97.2000.09% Maltodextrin NF/PH. EUR. (Kleptose) 2916.000 28.3% Mixed BerryFlavor Powder (MWNI) 102.000  1.0% FLV masking 644.000  6.3% Sodiumphosphate dibasic anhydrous USP 280.000  2.7% Sodium stearylfumerateNF/EP/JP 48.600  0.5%

These results showed that it was possible to exceed the taste maskingprovided by formulation C1 by altering the levels of sucralose, andchanging the flavorants. As formulation C1 was believed to be optimal,this change was a surprising improvement.

Example 7: Processing and Manufacture

Next, several processing steps including pre-blending, compaction, andfinal blending were subjected to optimization. Blending duration at thepre-blending stage can affect blend uniformity and pre-blend propertiesfor downstream compaction, and was therefore subjected to optimization.Specifically, three separate lots CCZHB, CCZHC, and CCZHD were subjectedto various blending times as shown in Table 26. The A&M Blender equippedwith a 16 Quart V-Shell, a 197S Quadro Comil with 062R comil screen, anda Gerteis Macro-pactor was used. Blend uniformity, flow index, bulk andtapped density, particle size distribution (PSD), reconstitution time,and dissolution were used as readouts. Blend Uniformity (BU) sampleswere taken from each batch from the 16 Quart V-Shell from 10 differentlocations (see FIG. 6 ). Table 27 summarizes BU results for all threebatches. The mean values ranged from 98.1 to 99.8% for PB and 98.1 to99.3% for TUDCA. The RSD ranged from 0.5 to 1.1% for PB and 1.3 to 1.9for TUDCA. FIG. 7 is a graph showing the PSD of the samples afterpre-blending.

TABLE 26 Blending Time with Lot# speed of 25 rpm Number of rotationsCCZHB 15 minutes 375 revolutions CCZHC 25 minutes and 645 revolutions(Mixing duration 48 seconds used in Registration batches) CCZHD 36minutes and 915 revolutions 36 seconds

TABLE 27 Blend Uniformity Results for Batches CCZHB, CCZHC and CCZHDPERCENTAGE OF API (%) Sample PB TUDCA Location CCZHB CCZHC CCZHD CCZHBCCZHC CCZHD Top 1 98.6 99.2 98.4 96.7 97.1 96.6 Top 2 98.2 99.7 98.0101.1 103.4 98.2 Top 3 97.9 100.6 100.5 97.6 99.5 101.7 Top 4 98.8 100.997.4 98.3 99.8 95.7 Middle 1 97.2 100.1 97.6 98.1 97.7 95.9 Middle 297.6 99.8 99.1 98.5 98.9 97.8 Middle 3 98.3 99.9 99.5 99.9 99.1 97.4Middle 4 98.0 100.8 99.4 98.9 100.3 99.3 Bottom 1 98.2 98.7 99.9 97.999.4 99.4 Bottom 2 98.5 98.7 100.0 97.9 98.2 99.0 Mean 98.1 99.8 99.098.5 99.3 98.1 Minimum 97.2 98.7 97.4 96.7 97.1 95.7 Maximum 98.8 100.9100.5 101.1 103.4 101.7 % RSD 0.5 0.8 1.1 1.3 1.7 1.9

A composite blend sample of 250 g was obtained for physicalcharacterization, including PSD, bulk density, tapped density and flowindex. Table 28 shows the physical testing results obtained for allthree batches (pre-blend and final blend).

TABLE 28 Pre-Blend Final blend CCYNH CCPKP CCZHB CCZHC CCZHD CCYNH CCPKPCCZHB CCZHC CCZHD PSD 10 (2000 μm) 0 0 0 0 0 0.06 0.06 0.07 0.18 0.18 14(1400 μm) 0.12 0.12 2.96 0.16 0.22 17.12 14.84 15.62 22.09 19.47 18(1000 μm) 1.34 1.22 3.99 2.49 1.32 20.34 17.94 16.89 21.02 20.45 30 (600μm) 6.04 5.48 66.23 55.20 5.39 19.13 16.30 18.48 19.47 18.61 40 (425 μm)9.88 9.65 21.24 37.35 13.63 8.42 8.82 8.79 7.85 8.01 80 (180 μm) 55.8745.27 4.77 4.80 52.40 16.26 16.96 18.97 13.87 13.21 PAN 26.75 38.26 0.810.00 27.04 18.67 25.08 21.18 15.52 20.07 (<180 μm) Total % 100.00 100.00100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 Bulk Density(g/mL) 0.46 0.48 0.47 0.48 0.49 0.63 0.67 0.63 0.63 0.63 Tapped Density(g/mL) 0.75 0.83 0.75 0.76 0.76 0.83 0.87 0.89 0.79 0.82 Flow Index (mm)28 26 34 26 26 14 14 9 9 12

Next, the dissolution and reconstitution time of the three batches wereanalyzed. The results are shown in Tables 29-31.

TABLE 29 Dissolution profile for TUDCA in pre-blending study Time:(minutes)/Batch 5 15 30 45 60 75 Average % Released CCZHB 92 96 96 96 9697 CCZHC 89 97 98 98 98 98 CCZHD 92 97 97 97 97 97

TABLE 30 Dissolution profile for PBA in pre-blending study Time:(minutes)/Batch 5 15 30 45 60 75 Average % Released CCZHB 94 97 97 97 9797 CCZHC 91 99 99 99 100 100 CCZHD 93 98 98 98 98 98

TABLE 31 Reconstitution time for Batch CCZHB, CCZHC and CCZHD Time Batch(minutes:seconds) CCZHB 13:04 CCZHC 11:03 CCZHD 11:57

No statistical significance was observed in the blend uniformity,dissolution or reconstitution time for the three batches. However,significant differences were observed in the PSD of the three batchesafter pre-blending. The pre-blend PSD for CCZHB and CCZHC, which weresubjected to a shorter blending time, indicated coarser materials. Thissuggests that increased blending time results in more particleattrition. A shorter pre-blending time is therefore preferred.

In the compaction step, several compaction parameters such as rollergap, compaction force and granulation screen size are likely to impactthe physical properties of the final granules, and the extent and rateof drug release. These factors were therefore subjected to optimization,and their effects on dissolution, physical properties, andreconstitution time were evaluated. Compaction speed is an additionalfactor that could impact physical properties and was evaluated alongduring the final blending study. A bulk blend (Lot CDCVY), pre-blendedbased on the optimal pre-blending parameters determined above wasdivided into twelve sub-batches, and roller compaction and granulationof each sub-batch was carried out using a set of different parametersfor compaction force (5-15 kN/cm), roller gap (2-3 mm) and graduationscreen size (1-2 mm) (Table 32). Physical properties, dissolution andreconstitution time on the final blend were evaluated for eachsub-batch. Tables 33 and 34 show physical testing results obtained forall 12 sub-batches.

TABLE 32 Roller compaction and granulation parameters Trial # Screen(mm) Gap (mm) Force (KN/cm) 1 1 3 15 2 1 3 5 3 1.5 2.5 10 4 2 3 15 5 2 35 6 1.5 2.5 10 7 1 2 15 8 1 2 5 9 1.5 2.5 10 10 2 2 5 11 2 2 15 12 1.52.5 10

TABLE 33 Sub-batches 1-6 Final blend TEST Sub-batch #1 Sub-batch #2Sub-batch #3 Sub-batch #4 Sub-batch #5 Sub-batch #6 PSD 10 (2000 μm)0.05 0.03 0.04 0.28 0.12 0.04 14 (1400 μm) 0.11 0.26 2.21 28.33 13.001.99 18 (1000 μm) 0.86 0.51 21.85 24.62 17.38 22.97 30 (600 μm) 25.3822.48 24.46 17.96 16.80 24.70 40 (425 μm) 17.01 15.02 10.68 7.20 8.5810.38 80 (180 μm) 30.08 30.90 19.70 11.10 20.66 19.53 PAN 26.51 30.8021.06 10.51 23.46 20.39 (<180 μm) Total % 100.00 100.00 100.00 100.00100.00 100.00 Bulk Density (g/mL) 0.62 0.57 0.63 0.63 0.60 0.63 TappedDensity (g/mL) 0.82 0.81 0.80 0.80 0.79 0.81 Flow Index (mm) 9 14 8 9 129

TABLE 34 Sub-batches 7-12 Pre-Blend Final blend TEST Sub-batch #7Sub-batch #8 Sub-batch #9 Sub-batch #10 Sub-batch #11 Sub-batch #12 PSD10 (2000 μm) 0.06 0.10 0.14 0.17 0.46 0.14 14 (1400 μm) 0.22 0.28 2.0017.60 27.58 2.53 18 (1000 μm) 0.92 0.79 21.13 19.08 22.83 24.26 30 (600μm) 28.94 25.98 23.37 17.11 17.82 25.65 40 (425 μm) 17.16 15.30 10.858.29 7.85 10.68 80 (180 μm) 28.96 30.15 20.95 19.84 13.34 18.98 PAN23.74 27.40 21.56 17.91 10.12 17.76 (<180 μm) Total % 100.00 100.00100.00 100.00 100.00 100.00 Bulk Density (g/mL) 0.64 0.59 0.61 0.60 0.610.62 Tapped Density (g/mL) 0.82 0.81 0.77 0.78 0.78 0.79 Flow Index (mm)9 12 9 14 9 9

FIGS. 8-10 show particle size distribution under granulation screensizes of 1.00 mm, 1.5 mm, and 2.0 mm, respectively; the combined resultsare shown in FIG. 11 .

The above physical characterization data was entered into Minitab v. 18statistical program and the statistical model was used to determine theoptimal compaction parameters based on the below set of responsetargets. The response target in regards to particle size distributionwas selected to achieve a narrow PSD for downstream packagingactivities.

TABLE 35 Response Particle Size Distribution Target Material > 1400 μmNMT 10% 425 μm < Material < 1400 μm 45% ≤ Material ≤ 65% Material < 425μm NMT 45% Reconstitution Time NMT 15 minutes TUDCA Dissolution Q = 75%→ individual values NLT 85% @ 15 minutes PB Dissolution Q = 75%individual values NLT 85% @ 15 minutes

Based on the statistical analysis, significant differences were observedin the PSD for all twelve sub-batches in the final blend. Bulk densityand flow index showed moderately significant differences in the overallstatistical analysis. The results from tapped density showed nosignificant difference. As physical characteristics of the final blendare important factors for downstream packaging, a homogeneous particlesize distribution is preferred. In order to achieve the above responsetargets, the optimal compaction parameters for the predicted model wasconsidered to be a roller gap width of about 2 mm to about 3 mm, acompaction force of about 5-15 kN/cm (target: 10.0 kN/cm) and agranulation screen size of about 1.5 mm.

Reconstitution Time and Dissolution Profile

Since the compaction process can impact the physical properties of thegranules and thus the extent and rate of drug release, reconstitutiontime and dissolution profile were further evaluated. Tables 36-38 listthe reconstitution time and mean dissolution profile for the twelvesub-batches. The dissolution profiles of TUDCA and sodium phenylbutyratein each of the sub-batches are shown in FIGS. 12 and 13 respectively.

TABLE 36 Reconstitution time Time: Sub-Batch (minutes:seconds) #1  9:14#2  8:30 #3 10:23 #4 13:19 #5 10:56 #6 12:06 #7 13:12 #8  9:27 #9 13:09#10 13:57 #11 16:31 #12 13:26

TABLE 37 Dissolution Profile for TUDCA Time: (minutes)/Sub-batch 5 15 3045 60 75 % Released #1 85 98 99 99 99 99 #2 88 97 98 98 98 98 #3 86 9798 98 98 98 #4 89 99 99 99 99 99 #5 90 100 98 100 100 100 #6 90 99 101101 101 101 #7 83 97 98 98 98 98 #8 89 97 98 98 97 98 #9 94 100 101 101101 101 #10 91 100 101 101 101 101 #11 92 101 101 101 101 101 #12 89 100101 101 101 101

TABLE 38 Dissolution Profile for PB Time: (minutes)/Sub-batch 5 15 30 4560 75 % Released #1 85 98 98 98 98 98 #2 87 97 97 97 97 97 #3 85 97 9797 97 97 #4 90 99 99 99 99 99 #5 86 96 97 97 97 97 #6 87 98 98 98 98 98#7 84 97 98 98 98 98 #8 88 97 97 97 97 97 #9 92 98 99 99 99 99 #10 92100 101 101 101 101 #11 93 101 101 101 101 101 #12 86 96 96 96 97 97

Moderately significant differences in the reconstitution time wereobserved among the different sub-batches. All twelve sub-batches met thebulk product specification of NMT (no more than) 20 minutes. In order toestablish a more sensitive limit, a reconstitution time of NMT=15minutes was entered into the statistical program as a response target.With this response target, no significant differences were observedamong the sub-batches, except for sub-batch #11, which had the longestreconstitution time of about 16 to 17 minutes.

The dissolution profiles were not strongly influenced by the parameterstested. TUDCA dissolution % release and PB dissolution % release bothappeared to be complete after 15 minutes. The dissolution % releaseresults were well above the target limit of Q=75% @ 15 minutes. FIGS. 12and 13 show dissolution profiles of the sub-batches.

To evaluate whether a lower temperature could impact the physicalproperties of the granules, a cooling unit at a temperature of 15±2° C.was added to the roller compactor. Reduced clumping and agglomerationwas observed from addition of the cooling unit.

Final Blending Optimization

Blending time during the final blending step could affect blenduniformity and final blend physical properties that are critical fordownstream packaging, and was therefore subjected to optimization. Table39 shows the varying duration and the corresponding number ofrevolutions used. Blend uniformity and physical characterization wereevaluated, BU samples were obtained from the locations shown in FIG. 14. The BU results are shown in Tables 40-42.

TABLE 39 Blending time with Level fixed speed 20.5 rpm Number ofrevolutions 1 0 minutes 0 revolutions 2 3 minutes 61.5 revolutions(Similar mixing duration used in Registration batches which was 60revolutions) 3 5 minutes 102.5 revolutions

TABLE 40 Batch CDCWH Pre-blend Sample Location % PBA % TUDCA Top 1 100.192.7 Top 2 100.3 98.8 Top 3 99.3 100.9 Middle 1 98.7 97.3 Middle 2 100.0101.3 Middle 3 98.5 98.1 Middle 4 101.1 98.2 Bottom 1 98.9 98.8 Bottom 298.0 99.6 Bottom 3 99.6 98.9 Mean 99.5 98.5 Min. 98.0 92.7 Max 101.1101.3 % RSD 1.0 2.4

Adequate pre-blend homogeneity was achieved, with mean values of 99.500for PB, 9800 for TUDCA, and % RSD values being less than 2.5% for bothactive pharmaceutical ingredients.

TABLE 41 Batch CDCWH compacted granules Sample Container #1 Container #2Container #1 Container #2 Location % PBA % TUDCA Top 94.5 96.0 96.7 98.5Middle 95.5 95.2 97.3 99.2 Bottom 98.0 94.0 97.0 98.2 Mean 96.0 95.197.0 98.2 Minimum 94.5 94.0 96.7 98.2 Maximum 98.0 96.0 97.3 99.2 % RSD1.9 1.1 0.3 0.5 Overall Mean 95.5 97.8 Overall Min. 94.0 96.7 OverallMax. 98.0 99.2 Overall RSD 1.5 1.0

Adequate homogeneity was also achieved after roller compaction, with anoverall mean value of 95.5% for PB, 97.8% for TUDCA, and % RSD valuesbeing less than 2.0% for both active pharmaceutical ingredients.

TABLE 42 Batch CDCWH final blend % PBA % TUDCA Sample No 3 minutes 5minutes No 3 minutes 5 minutes Location Blending blending blendingBlending blending blending Top 1 98.3 100.6 95.8 100.0 96.9 96.9 Top 2103.6 98.6 101.6 99.8 96.9 99.4 Top 3 98.8 99.2 100.0 99.5 98.9 97.6 Top4 99.6 101.3 99.9 97.9 99.4 98.5 Middle 1 101.3 99.7 98.7 98.3 98.8 98.7Middle 2 95.4 96.3 99.2 98.4 94.2 96.7 Middle 3 100.4 99.3 98.4 99.198.2 96.2 Middle 4 100.5 98.8 102.4 98.6 97.3 98.0 Bottom 1 94.0 100.2101.1 95.4 97.8 98.6 Bottom 2 98.5 99.3 99.2 98.3 97.8 99.0 Mean 99.099.3 99.6 98.5 97.6 98.0 Minimum 94.0 96.3 95.8 95.4 94.2 96.2 Maximum103.6 101.3 102.4 100.0 99.4 99.4 % RSD 2.8 1.3 1.9 1.3 1.5 1.1

No significant difference in blend uniformity was observed withdifferent final blending durations. Adequate final blend homogeneity wasachieved; with mean values ranging from 99.0 to 99.6% for PBA and 97.6to 98.5% for TUDCA. The % RSD ranged from 1.3 to 2.8% for PBA and 1.1 to1.5 for TUDCA. Higher variation in the BU results was observed when nofinal blending was performed, as compared to blending for either 3 or 5minutes, though the individual value at each location was well withinthe recommended range of 85%-115% for blend uniformity.

A composite blend sample of 250 g was obtained for physicalcharacterization. Table 43 lists the physical testing results. There wasno significant differences in the PSD, or the bulk and tapped density;however, there was a significant difference in the flow index. Improvedflow index was observed under the no blending condition. Shorterblending time also resulted in coarser materials. Therefore no finalblending was determined to be the preferred condition.

TABLE 43 Physical characterization Batch CDCWH Final Blend No 3 minutes5 minutes Test Blending blending blending PSD (%) 10 (2000 μm) 0 0 0 14(1400 μm) 1.16 1.34 1.30 18 (1000 μm) 18.31 17.70 17.08 30 (600 μm)23.73 22.18 22.14 40 (425 μm) 11.59 10.43 10.53 80 (180 μm) 21.38 20.4021.07 PAN (<180 μm) 23.83 27.95 27.88 Total 100.00 100.00 100.00 BulkDensity (g/mL) 0.60 0.62 0.63 Tapped Density (g/mL) 0.82 0.83 0.85 FlowIndex (mm) 9 16 14

TABLE 44 PSD Batch CDCWH No 3 minutes 5 minutes Particle SizeDistribution Target Blending blending blending Material > 1400 μm NMT10% 1.16 1.34 1.30 425 μm < Material < 1400 μm 45% ≤ Material ≤ 65%53.63 50.31 49.75 Material < 425 μm NMT 45% 45.21 48.38 48.95

Dissolution and Reconstitution Time

No statistical significance in dissolution or reconstitution wasobserved (Tables 45-47). Table 48 shows a preferred set of physicalcharacteristics for the bulk product.

TABLE 45 Dissolution profile for TUDCA (Batch CDCWH) Time:(minutes)/Blending Time 5 15 30 45 60 75 Average % Released No Blending89 96 96 96 96 96 3 minutes blending 90 97 97 97 97 97 5 minutesblending 87 95 96 96 96 95

TABLE 46 Dissolution profile for PBA (Batch CDCWH) Time:(minutes)/Blending Time 5 15 30 45 60 75 Average % Released No Blending90 95 95 95 95 95 3 minutes blending 93 98 98 98 98 98 5 minutesblending 90 98 98 98 98 98

TABLE 47 Reconstitution time (Batch CDCWH) Blending time Time (minutes)No Blending 16 3 minutes blending 15 5 minutes blending 15

TABLE 48 Particle Size Distribution Target Material > 1400 μm *NMT 10%425 μm < Material < 1400 μm 45% ≤ Material ≤ 65% Material < 425 μm NMT50% Bulk Density 0.5-0.7 g/mL Tapped Density 0.7-0.9 g/mL Flow Index**NLT 16 mm *NMT: Not More Than **NLT: Not Less Than

The above optimization studies revealed preferred processing conditionsto achieve improved flow properties and reduced levels of fine particlesin the final product, which are thought to be detrimental to flow. Itwas determined that: i. a pre-blending time corresponding to about 375revolutions, ii. a compaction force of between 5-15 kN/cm, gap width ofbetween about 1.0 mm to about 5.0 mm, roller speed of about 4 to about12 rpm, and granulation screen size of about 1.5 mm, and iii. no finalblending, resulted in improved product properties including flowability.Together these improvements resulted in a Carr's Index of approximately8-9, a significant and surprising improvement from the originalformulation developed (˜20 Carr Index).

Statistical Analysis

The results from the compaction study was subjected to statisticalanalysis. The input settings were as follows:

Factor Minimum Center Maximum Screen Size (mm) 1.0 1.5 2.0 Gap Width(mm) 2.0 2.5 3.0 Press Force 5.0 10.0 15.0 (kN/cm)

The following physical responses were analyzed: % Retained on 10 mesh, %Retained on 14 mesh, % Retained on 18 mesh, % Retained on 30 mesh, %Retained on 40 mesh, % Retained on 80 mesh, % Pan, Bulk Density, TappedDensity, and Flow Index.

Results—Particle Size Distribution Responses

Good or very good models were found for each of the particle sizedistribution responses (% Retained on 10 mesh, % Retained on 14 mesh, %Retained on 18 mesh, % Retained on 30 mesh, % Retained on 40 mesh, %Retained on 80 mesh, and % Pan).

The main effects of Screen Size and Press Force, and the Screen Forceinteraction effect were statistically significant with ≥95% confidencein each of these models. The curvature effect was also significant ineach of the PSD response models except % Retained on 10 mesh and % Pan.The presence of the curvature term in a model indicates that at leastone of the main factors has a quadratic effect on the responses. The GapWidth main effect was statistically significant with ≥95% confidence inthe models for % Retained on 30 mesh and for % Pan.

The model coefficient for Screen Size was positive in the models for %Retained on 10 mesh, % Retained on 14 mesh, and % Retained on 18 mesh,while the coefficient is negative in the models for % Retained on 30mesh, % Retained on 40 mesh, % Retained on 80 mesh, and % Pan. Thisindicates that increasing the Screen Size tends to increase the amountof larger particles and decrease the amount of smaller particles in thecompacted blend.

Similarly, the model coefficient for Press Force was positive in themodels for % Retained on 10 mesh, % Retained on 14 mesh, % Retained on18 mesh, % Retained on 30 mesh, and % Retained on 40 mesh, while thecoefficient is negative in the models for % Retained on 80 mesh and %Pan. This indicates that increasing the Press Force also tends toincrease the amount of larger particles and decrease the amount ofsmaller particles in the compacted blend.

The model coefficient for Gap Width was negative for % Retained on 10mesh and % Retained on 30 mesh. It was approximately equal to zero for %Retained on 14 mesh, % Retained on 18 mesh, % Retained on 40 mesh, and %Retained on 80 mesh. The Gap Width coefficient is positive for % Pan.Therefore, increasing Gap Width may decrease the amount of largerparticles and increase the amount of smaller particles in the compactedblend.

Good predictive models were also found for the Bulk Density and FlowIndex.

Example 8: Forced Degradation Studies

Each API and the final formulation (referred to as “AMX powder insachet”) containing both APIs were also subjected to forced degradationstudies. The study included stressing samples of PB (sodiumphenylbutyrate) API, TURSO API, placebo, and AMX Powder in Sachet underthermal, thermal-humidity, light, oxidation, acid, or base conditions(Table 49).

TABLE 49 % Degradation Observed Stress Stress Condition PB TURSO AMXPowder Samples Condition Details API API in Sachet PB API Thermal 85° C.for 10 days None None PB: ~8% (4500 mg/sample), TURSO: ~19% TURSO APIThermal- 85° C. + 1.0 mL water per None 100%  PB: ~4% (1500 mg/sample),Humidity sample for 10 days TURSO: ~10% Placebo mixture, Oxidation 10 mLof 3% H₂O₂ per None  3% PB: None and AMX Powder in sample TURSO: ~2%Sachet Acid 10 mL of 1.0N HCl per None None None (4500 mg PB and samplefor 3 days at 50° C. 1500 mg TURSO 10 mL of 1.0N HCl per None ~3% Noneper sample) sample for 7 days at 50° C. Base 10 mL of 1.0N NaOH per None~5% None sample for 3 days at 50° C. 10 mL of 1.0N NaOH per None ~17% None sample for 7 days at 50° C. 1 × ICH condition Light (White lightNLT 1.2 None None None million lux hours and UV light NLT 200 Whours/m²)

The assay results of the control and stress sample are summarized inTable 50. The Relative Mass Balance Deficit values are listed in Table51.

The PB API did not degrade in any of the forced degradation conditionsstudied. The TURSO API did not degrade in thermal and light conditions.It degraded slightly in acidic condition by Day 7 and in oxidation andbase condition by Day 3. By Day 7, TURSO API degraded by ˜17% in basecondition. The TURSO API in Thermal-Humidity condition completelychanged in nature or precipitated in solution as no TURSO peak wasdetected in the assay sample solution. The exposure of placebo mixtureto forced degradation conditions did not generate any peaks thatinterfered at the retention times of active peaks.

The PB and TURSO in AMX Powder in Sachet did not degrade in acid, base,and light conditions. PB in sachet did not degrade in oxidationcondition, but degraded by approximately 8% and 4% in Thermal andThermal-Humidity condition, respectively. TURSO in sachet slightlydegraded in oxidation condition and by 19% and 10% in Thermal andThermal-Humidity condition, respectively. Furthermore, surprisingly, theextent of TURSO degradation in Thermal-Humidity condition was much lowerin sachet compared to full degradation in TURSO API sample.

TABLE 50 Thermal- Acid 3 Sample Results Control Thermal HumidityOxidation Days PB API % PB 99.2 98.9 99.3 98.6 99.1 % PB remaining 99.7100.1  99.4 99.9 PB Peak Purity Pass Pass Pass Pass Pass Conclusion Nosignificant No significant No significant No significant DegradationDegradation Degradation Degradation TUDCA % TUDCA 100.2  100.6  TUDCAPeak was 97.1 100.0  API not detected. Solution appeared cloudy/white.*% TUDCA 100.4  0% 96.9 99.8 remaining TUDCA Peak Fail Fail N/A (no peak)Fail Fail Purity Conclusion No significant Full degradation/ ~3% Nosignificant Degradation sample degradation Degradation precipitation mayhave occurred Placebo % PB ND ND ND ND ND % TUDCA ND ND ND ND NDConclusion Causes no Causes no Causes no Causes no interference atinterference at interference at interference at retention time ofretention time of retention time retention time actives actives ofactives of actives AMX-0035 % PB 99.1 90.8 94.7 98.5 98.9 Powder in %TUDCA 97.2 78.4 87.1 95.2 96.1 Sachet % PB remaining 91.6 95.6 99.4 99.8% TUDCA 80.7 89.6 97.9 98.9 remaining PB Peak Purity Pass Pass Pass PassPass TUDCA Peak Fail Fail Fail Fail Fail Purity Conclusion ~8% PB and~4% PB and PB-No No significant ~19% TUDCA ~10% TUDCA significantDegradation degradation degradation degradation, TUDCA - ~2% Base 3 Acid7 Base 7 Light Sample Results Days Days Days Control Light PB API % PB98.9 99.7 99.8 99.0 98.3 % PB remaining 99.7 100.5  100.6  99.3 PB PeakPurity Pass Pass Pass Pass Pass Conclusion No significant No significantNo significant No significant Degradation Degradation DegradationDegradation TUDCA % TUDCA 95.1 97.2 82.8 96.4 99.5 API % TUDCA 94.9 97.082.6 103.2  remaining TUDCA Peak Fail Fail Fail Fail Fail PurityConclusion ~5% ~3% ~17% No significant degradation degradationdegradation Degradation Placebo % PB ND ND ND ND ND % TUDCA ND ND ND NDND Conclusion Causes no Causes no Causes no Causes no interference atinterference at interference at interference at retention time retentiontime retention time retention time of actives of actives of actives ofactives AMX-0035 % PB 99.0 98.9 99.2 99.2 99.6 Powder in % TUDCA 97.496.4 97.1 96.8 97.1 Sachet % PB remaining 99.9 99.8 100.1  100.4  %TUDCA 100.2  99.2 99.9 100.3  remaining PB Peak Purity Pass Pass PassPass Pass TUDCA Peak Fail Fail Fail Fail Fail Purity Conclusion Nosignificant No significant No significant No significant DegradationDegradation Degradation Degradation *Two additional samples wereprepared and analyzed after 3 and 7 days of exposure to the sameThermal-Humidity condition (85° C. with 1.0 mL water). The resultsconfirmed that TUDCA samples fully degrade in the exposed condition.Only 1.30% TUDCA was detected in Day 3 sample (Ref PDS-NB-16454 pg.019).

TABLE 51 Thermal- Acid Base Acid Base Light Sample Results ControlThermal Humidity Oxidation 3 Days 3 Days 7 Days 7 Days Control Light PBAPI % Potency 99.2 98.9 99.3 98.6 99.1 98.9 99.7 99.8 99.0 98.3 % TotalRS 2.07 3.93 1.18 3.13 1.18 1.11 1.14 1.10 0.96 0.74 Mass Balance 101.27102.83 100.48 101.73 100.28 100.01 100.84 100.90 99.96 99.04 % RMBD N/A101.5 99.2 100.5 99.0 98.8 99.6 99.6 N/A 99.1 TUDCA API % Potency 100.2100.6 ND 97.1 100.0 95.1 97.2 82.8 96.4 99.5 % Totals RS 0.22 0.28 ND1.36 0.23 0.22 0.20 0.18 0.22 0.24 Sum 100.42 100.88 0.00 98.46 100.2395.32 97.40 82.98 96.62 99.74 % RMBD N/A 100.5 0.0 98.0 99.8 94.9 97.882.6 N/A 103.2 AMX-0035 % PB Potency 99.1 90.8 94.7 98.5 98.9 99.0 98.999.2 99.2 99.6 Powder in % Total PB 0.78 12.12 2.90 2.01 1.14 2.28 1.102.42 0.86 0.81 Sachet impurity PB Sum 99.88 102.92 97.60 100.51 100.04101.28 100.0 101.62 100.06 100.41 % RMBD N/A 103.0 97.7 100.6 100.2101.4 100.1 101.7 N/A 100.3 % TUDCA 97.2 78.4 87.1 95.2 96.1 97.4 96.497.1 96.8 97.1 Potency % Total TUDCA 1.19 1.33 1.20 1.64 1.31 1.19 1.311.20 1.21 1.18 Impurity TUDCA Sum 98.39 79.73 88.30 96.84 97.41 98.5997.71 98.30 98.01 98.28 % RMBD N/A 81.0 89.7 98.4 99.0 100.2 99.3 99.9N/A 100.3

Example 9: Effect of Cooling Unit on Blend Properties

A placebo batch (Lot #CFSMM) was prepared where a cooling unit (15±2°C.) was added to the roller compactor. The temperature on the roller(nip area) during the entire batch was between 16.0-24.1° C. Thetemperature of the granules during the entire batch was between24.8-29.0° C. No accumulation was observed on the rotary 1.5 mm screenduring the entire batch. Table 52, 53, and FIGS. 15 and 16 show physicalproperties of the pre-blend and compacted granules. As shown in Table53, compared to the flow index of lot CDZGW, which was prepared withoutthe cooling unit, Lot CFSMM showed reduced flow index (i.e. improvedflow properties). These results suggest that cooling the rollercompactor can be beneficial for the processing conditions.

TABLE 52 Pre-blend results Particle Size Distribution Material: 100grams of Pre-blend % Retained Placebo TRUE PLACEBO SCALE-UP - FEAS 2000KG Lot: Lot: Lot: Lot: Lot: Lot: Lot: CFSMM CFSMM CFSMM CFSMM CFSMMCFSMM Aperture CDZGW PRE- PRE- PRE- PRE- PRE- PRE- Mesh (microns) (360kg) BLEND 1 BLEND 2 BLEND 3 BLEND 4 BLEND 5 BLEND 6 10 2000 0.00 0.000.01 0.00 0.00 0.00 0.00 14 1400 0.00 0.08 0.20 0.13 0.05 0.00 0.00 181000 0.03 0.97 0.80 1.40 1.12 0.64 0.50 30 600 0.41 2.18 2.58 3.08 2.822.62 2.75 40 425 4.20 6.57 7.28 8.17 8.45 7.58 7.49 80 180 53.22 51.6252.16 53.03 51.53 52.10 50.93 PAN <180 42.14 38.58 36.97 34.19 36.0337.06 38.33 Total — 100.00 100.00 100.00 100.00 100.00 100.00 100.00Bulk and Tapped Density Material: 100 grams of Pre-blend Unit ofMeasurement: g/mL Placebo TRUE PLACEBO SCALE-UP - FEAS 2000 KG Lot: Lot:Lot: Lot: Lot: Lot: Lot: CFSMM CFSMM CFSMM CFSMM CFSMM CFSMM CDZGW PRE-PRE- PRE- PRE- PRE- PRE- (360 kg) BLEND 1 BLEND 2 BLEND 3 BLEND 4 BLEND5 BLEND 6 Bulk Density 0.63 0.60 0.63 0.64 0.63 0.64 0.63 Tapped Density0.83 0.78 0.81 0.78 0.79 0.81 0.81 Flow Index Material: 50 grams ofPre-blend Unit of Measurement: mm Placebo AMX-0035 TRUE PLACEBOSCALE-UP - FEAS 2000 KG Lot: Lot: Lot: Lot: Lot: Lot: Lot: CFSMM CFSMMCFSMM CFSMM CFSMM CFSMM CDZGW PRE- PRE- PRE- PRE- PRE- PRE- (360 kg)BLEND 1 BLEND 2 BLEND 3 BLEND 4 BLEND 5 BLEND 6 Flow Index 5 9 7 6 8 912

TABLE 53 Compacted granules results Particle Size Distribution Material:100 grams of Compacted Granules % Retained Placebo AMX-0035 TRUE PLACEBOSCALE-UP - FEAS 2000 KG Lot# Lot# Lot# Lot# Lot# Lot: Lot# CFSMM CFSMMCFSMM CFSMM CFSMM Lot# Lot# Aperture CDZGW CFSMM After After After AfterAfter CFSMM CFSMM Mesh (microns) (360 kg) Beginning Bin 1 Bin 2 Bin 3Bin 4 Bin 5 End Composite 10 2000 0 0.00 0.00 0.00 0.00 0.00 0.00 0.000.00 14 1400 0.75 0.23 0.19 0.30 0.27 0.12 0.42 0.51 0.15 18 1000 16.6011.72 7.85 10.22 9.42 5.39 14.33 14.99 9.60 30 600 22.20 19.92 17.1019.42 17.49 12.15 20.57 21.66 17.61 40 425 11.31 11.83 11.82 12.64 11.759.38 10.88 11.25 11.17 80 180 23.38 27.85 29.95 29.04 30.29 30.34 25.2524.82 29.36 PAN <180 25.76 28.45 33.09 28.38 30.78 42.62 28.55 26.7732.11 Total — 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00100.00 Bulk and Tapped Density Material: 100 grams of Compacted GranulesUnit of Measurement: g/mL Placebo AMX-0035 TRUE PLACEBO SCALE-UP - FEAS2000 KG Lot# Lot# Lot# Lot# Lot# Lot: Lot# CFSMM CFSMM CFSMM CFSMM CFSMMLot# Lot# CDZGW CFSMM After After After After After CFSMM CFSMM (360 kg)Beginning Bin 1 Bin 2 Bin 3 Bin 4 Bin 5 End Composite Bulk Density 0.630.68 0.67 0.65 0.66 0.68 0.67 0.67 0.68 Tapped Density 0.88 0.91 0.910.86 0.88 0.91 0.88 0.88 0.88 Flow Index Material: 50 grams of CompactedGranules Unit of Measurement: mm Placebo AMX-0035 TRUE PLACEBOSCALE-UP - FEAS 2000 KG Lot# Lot# Lot# Lot# Lot# Lot: Lot# CFSMM CFSMMCFSMM CFSMM CFSMM Lot# Lot# CDZGW CFSMM After After After After AfterCFSMM CFSMM (360 kg) Beginning Bin 1 Bin 2 Bin 3 Bin 4 Bin 5 EndComposite Flow Index 14 8 10 12 12 12 10 10 10

1.-77. (canceled)
 78. A composition comprising about 27% to about 32%w/w of sodium phenylbutyrate and about 8% to about 12% w/w oftaurursodiol (TURSO), wherein the composition is prepared by a methodcomprising dry granulating sodium phenylbutyrate, TURSO and one or moreexcipients.
 79. The composition of claim 78, wherein about 45% to about65% of particles in the composition have a size of between about 425 μmto about 1400 μm.
 80. The composition of claim 78, wherein about 10% orless of particles in the composition have a size larger than about 1400μm.
 81. The composition of claim 78, wherein about 50% or less ofparticles in the composition have a size smaller than about 425 μm. 82.The composition of claim 78, wherein the composition has a Carr's indexof about 24 or less.
 83. The composition of claim 78, wherein thecomposition has a Carr's index of about 20 or less.
 84. The compositionof claim 78, wherein the method comprises roller compacting the sodiumphenylbutyrate, TURSO and one or more excipients.
 85. The composition ofclaim 78, wherein the method comprises using a granulation screen with adiameter larger than about 1 mm.
 86. The composition of claim 78,wherein the composition is in powder form.
 87. The composition of claim78, wherein the composition comprises about 14% to about 17% w/w ofdextrates.
 88. The composition of claim 78, wherein the compositioncomprises about 3.5% to about 4.5% w/w of sorbitol.
 89. The compositionof claim 78, wherein the composition comprises about 0.05% to about 1.5%w/w of silicon dioxide.
 90. The composition of claim 78, wherein thecomposition comprises about 25% to about 32% w/w of maltodextrin. 91.The composition of claim 78, wherein the composition comprisessucralose, flavorants, buffering agents, and/or lubricants.
 92. Thecomposition of claim 78, wherein the composition comprises about 28% toabout 30% w/w of sodium phenylbutyrate.
 93. The composition of claim 78,wherein the composition comprises about 9% to about 10% w/w of TURSO.